NPI | 1437209459 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS016988) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: DE 934) | |
Enumeration Date | 2007-01-11 |
Last Update Date | 2017-02-27 |