| 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 |