| NPI | 1508660465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YS0200X Counselor, School |
| 103TC1900X Psychologist, Counseling | |
| 103TR0400X Psychologist, Rehabilitation | |
| Enumeration Date | 2025-04-01 |
| Last Update Date | 2025-04-09 |