| NPI | 1679200471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO 4521033015) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AR 458632154989544) |
| 101YM0800X Counselor, Mental Health (Licence: OK 8469754655565) | |
| 103TC0700X Psychologist, Clinical (Licence: UT 11564758-4805) | |
| Enumeration Date | 2022-08-02 |
| Last Update Date | 2026-04-25 |