| NPI | 1396286761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2017-03-17 |
| Last Update Date | 2017-03-17 |