NPI | 1033766514 |
---|---|
Former Name | MARY KIEUN PARK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: TX 39669) |
Additional Taxonomies | 103T00000X Psychologist |
Enumeration Date | 2019-08-20 |
Last Update Date | 2025-05-29 |