| NPI | 1720632631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging |
| Enumeration Date | 2019-07-29 |
| Last Update Date | 2023-10-11 |