| NPI | 1689149171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6352001089) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 103K00000X Behavior Analyst | |
| Enumeration Date | 2018-10-10 |
| Last Update Date | 2025-05-14 |