NPI | 1972859148 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TH0100X Psychologist, Health Service (Licence: MA 10733) |
Additional Taxonomies | 103T00000X Psychologist (Licence: MN 6971) |
103TC1900X Psychologist, Counseling (Licence: NH 4201) | |
Enumeration Date | 2012-07-25 |
Last Update Date | 2025-03-04 |