NPI | 1174725998 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: MA 8811) |
Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MA 8811) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2007-06-04 |
Last Update Date | 2018-06-05 |