| NPI | 1164814208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| 103TF0200X Psychologist, Forensic | |
| 103TR0400X Psychologist, Rehabilitation | |
| Enumeration Date | 2015-02-26 |
| Last Update Date | 2015-02-26 |