| NPI | 1588370969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TS0200X Psychologist School |
| 171M00000X Case Manager/Care Coordinator | |
| 1744R1102X Specialist Research Study | |
| 1744R1103X Specialist Research Data Abstracter/Coder | |
| Enumeration Date | 2023-01-27 |
| Last Update Date | 2023-01-27 |