| NPI | 1063906956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103TF0200X Psychologist, Forensic | |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2023-08-23 |