| NPI | 1770346181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 103TF0000X Psychologist, Family |
| 103TS0200X Psychologist, School | |
| 374700000X Technician | |
| Enumeration Date | 2024-01-31 |
| Last Update Date | 2026-07-22 |