| NPI | 1285415687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 103K00000X Behavior Analyst | |
| 103T00000X Psychologist | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| 103TA0700X Psychologist, Adult Development & Aging | |
| 103TH0100X Psychologist, Health Service | |
| Enumeration Date | 2023-10-11 |
| Last Update Date | 2023-10-11 |