NPI | 1962810804 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: NE 929) |
Additional Taxonomies | 101Y00000X Counselor (Licence: NE 4770) |
101Y00000X Counselor (Licence: NE 530) | |
Enumeration Date | 2014-07-23 |
Last Update Date | 2017-07-03 |