NPI | 1730317082 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: PR 3458) |
Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: PR 3458) |
Enumeration Date | 2009-06-25 |
Last Update Date | 2019-11-22 |