| NPI | 1760880892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TM1800X Psychologist, Intellectual & Developmental Disabilities |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral |
| Enumeration Date | 2014-12-05 |
| Last Update Date | 2014-12-05 |