| NPI | 1598092504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY7049) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: FL PY7049) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: FL PY7049) | |
| Enumeration Date | 2009-11-11 |
| Last Update Date | 2026-01-23 |