NPI | 1922112671 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MS 36-603) |
Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: LA 881) |
Enumeration Date | 2006-08-19 |
Last Update Date | 2013-01-11 |