NPI | 1033730296 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist |
Additional Taxonomies | 103TC1900X Psychologist, Counseling |
103TB0200X Psychologist, Cognitive & Behavioral | |
103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
Enumeration Date | 2020-04-29 |
Last Update Date | 2020-04-29 |