| NPI | 1518505072 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6361008122) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: MI 6362009864) |
| Enumeration Date | 2019-12-16 |
| Last Update Date | 2025-01-07 |