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 |