| NPI | 1679832547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: FL 1633) |
| Enumeration Date | 2012-05-11 |
| Last Update Date | 2025-10-09 |