NPI | 1386012524 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TS0200X Psychologist, School (Licence: MA 522908) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
103T00000X Psychologist | |
Enumeration Date | 2015-09-04 |
Last Update Date | 2023-04-12 |