NPI | 1114936614 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health |
Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: TX E1307) |
2080A0000X Pediatrics, Adolescent Medicine (Licence: TX E1307) | |
Enumeration Date | 2006-08-05 |
Last Update Date | 2025-09-11 |