NPI | 1104479930 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: TX 115868) |
Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: TX 115868) |
Enumeration Date | 2019-07-21 |
Last Update Date | 2021-04-18 |