NPI | 1962615252 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: DE PC-0000439) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA PS-006161-L) |
103TC1900X Psychologist, Counseling (Licence: PA PS-006161-L) | |
Enumeration Date | 2007-05-07 |
Last Update Date | 2018-08-01 |