| NPI | 1093982092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 25987) |
| 101YM0800X Counselor, Mental Health (Licence: CO LPC.0016363) | |
| 101YM0800X Counselor, Mental Health (Licence: CA LPCC.9293) | |
| 101YM0800X Counselor, Mental Health (Licence: FL MH.18797) | |
| Enumeration Date | 2008-05-09 |
| Last Update Date | 2022-11-28 |