| NPI | 1194531046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA 000) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) | |
| 103TB0200X Psychologist Cognitive & Behavioral | |
| Enumeration Date | 2024-12-05 |
| Last Update Date | 2024-12-05 |