| NPI | 1669405270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MD 408449700, 409426300) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD 408449700) |
| 101YM0800X Counselor, Mental Health (Licence: MD 408449700) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: MD 408449700) | |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2025-09-11 |