NPI | 1043565419 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist |
Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2012-07-20 |
Last Update Date | 2018-05-16 |