| NPI | 1548843071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 102L00000X Psychoanalyst |
| 102L00000X Psychoanalyst (Licence: CO xxx) | |
| Enumeration Date | 2021-05-03 |
| Last Update Date | 2021-05-03 |