| NPI | 1710225719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: NC 22232) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP1600X Counselor, Pastoral | |
| 103TC1900X Psychologist, Counseling | |
| Enumeration Date | 2013-01-25 |
| Last Update Date | 2021-04-28 |