| NPI | 1396727376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 3840) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MN 7561) |
| 103TC0700X Psychologist, Clinical (Licence: WI 3840123) | |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2025-09-11 |