| NPI | 1548396450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2021-12-29 |