NPI | 1740355288 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: GA PSY003603) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: GA LPC005028) |
103TC1900X Psychologist, Counseling (Licence: GA PSY003603) | |
Enumeration Date | 2006-11-21 |
Last Update Date | 2012-09-18 |