| NPI | 1770950826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 5275) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 5038) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS20605) | |
| 101YM0800X Counselor, Mental Health (Licence: NC A10955) | |
| 101YP2500X Counselor, Professional (Licence: NC A10955) | |
| Enumeration Date | 2015-08-25 |
| Last Update Date | 2017-11-20 |