| NPI | 1447885801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TP2701X Psychologist Group Psychotherapy |
| Additional Taxonomies | 374K00000X Religious Nonmedical Practitioner |
| Enumeration Date | 2020-03-05 |
| Last Update Date | 2021-02-26 |