| NPI | 1700364734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TC1900X Psychologist, Counseling | |
| 103TF0200X Psychologist, Forensic | |
| Enumeration Date | 2018-08-01 |
| Last Update Date | 2024-07-30 |