| NPI | 1205358397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 247200000X Technician, Other |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| Enumeration Date | 2017-07-11 |
| Last Update Date | 2023-10-17 |