| NPI | 1285809392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 31505) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IN 39001951A) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IN 87000390A) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 168501) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IN 39001951A) | |
| 101YM0800X Counselor, Mental Health (Licence: IN 3900195aA) | |
| 101YM0800X Counselor, Mental Health (Licence: IN 39001951A) | |
| 101YS0200X Counselor, School (Licence: 964686) | |
| 106H00000X Marriage & Family Therapist (Licence: IN 35001731A) | |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2023-03-14 |