| NPI | 1790525988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041S0200X Social Worker, School |
| Additional Taxonomies | 101YS0200X Counselor, School |
| 103TF0000X Psychologist, Family | |
| 103TS0200X Psychologist, School | |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2024-05-28 |
| Last Update Date | 2024-05-28 |