NPI | 1689068264 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: CA 31412) |
Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: IA 083818) |
Enumeration Date | 2015-03-23 |
Last Update Date | 2019-11-19 |