| NPI | 1285060244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD LC17501) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities | |
| 103K00000X Behavior Analyst | |
| 103TR0400X Psychologist, Rehabilitation | |
| 101YS0200X Counselor, School | |
| 101YM0800X Counselor, Mental Health | |
| 103TA0700X Psychologist, Adult Development & Aging | |
| Enumeration Date | 2013-09-23 |
| Last Update Date | 2026-03-04 |