| NPI | 1194005660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AK 149234) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AK 3771) |
| 101YM0800X Counselor, Mental Health (Licence: AK PSY O 83) | |
| 103T00000X Psychologist (Licence: AK PSYA673) | |
| Enumeration Date | 2011-08-27 |
| Last Update Date | 2022-01-07 |