NPI | 1750436457 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MA 9422) |
Additional Taxonomies | 101YM0800X Counselor Mental Health |
101YS0200X Counselor School | |
Enumeration Date | 2007-01-24 |
Last Update Date | 2011-09-28 |