| NPI | 1477962173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IN 20043782B) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-16-097) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2014-08-06 |
| Last Update Date | 2024-08-19 |