| NPI | 1962023184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2020-04-28 |
| Last Update Date | 2023-12-20 |