| NPI | 1104695683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP1600X Counselor, Pastoral | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| Enumeration Date | 2023-12-26 |
| Last Update Date | 2023-12-26 |