NPI | 1790285377 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810008334) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC012077) |
101YP2500X Counselor, Professional (Licence: VA 0701011884) | |
Enumeration Date | 2018-02-20 |
Last Update Date | 2023-11-09 |