| NPI | 1669524740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR 3261) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 372600000X Adult Companion | |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2023-07-24 |