NPI | 1891163804 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NY 007837) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 74384) |
103TC1900X Psychologist, Counseling (Licence: NY 007837) | |
103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 007837) | |
Enumeration Date | 2015-09-08 |
Last Update Date | 2024-11-18 |