NPI | 1891937900 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 38296) |
Additional Taxonomies | 101Y00000X Counselor (Licence: TX 63333) |
Enumeration Date | 2009-04-03 |
Last Update Date | 2019-10-10 |