| NPI | 1629600267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 94025920) |
| 103T00000X Psychologist (Licence: CA 94025920) | |
| Enumeration Date | 2020-02-11 |
| Last Update Date | 2022-06-30 |