| NPI | 1093526923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YS0200X Counselor, School | |
| 103K00000X Behavior Analyst | |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| 103TR0400X Psychologist, Rehabilitation | |
| 104100000X Social Worker | |
| Enumeration Date | 2025-01-20 |
| Last Update Date | 2025-01-20 |