NPI | 1700330651 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: NC 5476) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 10947) |
101YM0800X Counselor, Mental Health (Licence: NE 565) | |
Enumeration Date | 2016-08-09 |
Last Update Date | 2019-05-24 |