| NPI | 1033636691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 103TE1100X Psychologist, Exercise & Sports |
| 103TF0000X Psychologist, Family | |
| 171M00000X Case Manager/Care Coordinator | |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2017-08-24 |
| Last Update Date | 2025-02-06 |