| NPI | 1588140289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 103T00000X Psychologist | |
| Enumeration Date | 2018-07-16 |
| Last Update Date | 2024-04-23 |