| NPI | 1801522420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR R272) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2022-07-26 |
| Last Update Date | 2024-09-10 |