| NPI | 1306782867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TA0700X Psychologist, Adult Development & Aging |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 171W00000X Contractor | |
| 171WH0202X Contractor, Home Modifications | |
| 3747P1801X Technician, Personal Care Attendant | |
| Enumeration Date | 2026-04-27 |
| Last Update Date | 2026-04-27 |