| NPI | 1982164182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WI 5356-57) |
| Additional Taxonomies | 1041S0200X Social Worker School |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2025-05-27 |