| NPI | 1104268952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TM1800X Psychologist, Intellectual & Developmental Disabilities |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2013-07-22 |
| Last Update Date | 2013-07-22 |