NPI | 1255629572 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TA0400X Psychologist Addiction (Substance Use Disorder) |
Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: TX 36605) |
103TE1100X Psychologist Exercise & Sports | |
103TP2701X Psychologist Group Psychotherapy | |
Enumeration Date | 2011-07-20 |
Last Update Date | 2022-08-16 |