NPI | 1669405270 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD 408449700) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD 408449700) |
103TB0200X Psychologist, Cognitive & Behavioral (Licence: MD 408449700, 409426300) | |
103TR0400X Psychologist, Rehabilitation (Licence: MD 408449700) | |
Enumeration Date | 2006-07-08 |
Last Update Date | 2007-07-09 |