| NPI | 1235404724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY8491) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: FL PY8491) |
| 103T00000X Psychologist (Licence: FL PY# 8491) | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: FL PY8491) | |
| Enumeration Date | 2012-03-15 |
| Last Update Date | 2026-06-05 |