| NPI | 1144586413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TS0200X Psychologist, School |
| Additional Taxonomies | 103T00000X Psychologist |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2012-04-11 |
| Last Update Date | 2023-08-08 |