NPI | 1669933719 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AK 180102) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
103TC0700X Psychologist, Clinical (Licence: VA 7296) | |
Enumeration Date | 2019-03-29 |
Last Update Date | 2023-10-03 |