| NPI | 1740839463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
| 103TF0200X Psychologist, Forensic | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 103G00000X Clinical Neuropsychologist | |
| Enumeration Date | 2019-09-05 |
| Last Update Date | 2025-09-23 |