NPI | 1255926143 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 405300000X Prevention Professional (Licence: MI 680115877) |
Additional Taxonomies | 103TM1800X Psychologist, Intellectual & Developmental Disabilities |
Enumeration Date | 2021-03-03 |
Last Update Date | 2021-03-03 |