| NPI | 1285143412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101Y00000X Counselor |
| 102L00000X Psychoanalyst | |
| 103TC1900X Psychologist, Counseling | |
| Enumeration Date | 2017-09-19 |
| Last Update Date | 2024-07-01 |