| NPI | 1790531846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical | |
| 1041S0200X Social Worker, School | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| Enumeration Date | 2024-04-29 |
| Last Update Date | 2024-04-29 |