| NPI | 1194556860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: VA 0704015007) |
| Enumeration Date | 2024-08-13 |
| Last Update Date | 2024-08-22 |