NPI | 1962023184 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
Additional Taxonomies | 103TC1900X Psychologist, Counseling |
101YM0800X Counselor, Mental Health | |
Enumeration Date | 2020-04-28 |
Last Update Date | 2023-12-20 |