NPI | 1679836001 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: TX 37176) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 67890) |
Enumeration Date | 2012-06-20 |
Last Update Date | 2016-02-15 |