| NPI | 1053606814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC C007223) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral |
| Enumeration Date | 2011-06-09 |
| Last Update Date | 2023-02-27 |