| NPI | 1710572573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health | |
| 101YP2500X Counselor, Professional | |
| 103K00000X Behavior Analyst | |
| 103T00000X Psychologist | |
| 103TC1900X Psychologist, Counseling | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| Enumeration Date | 2021-03-03 |
| Last Update Date | 2021-03-03 |