| NPI | 1780396689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101200000X Drama Therapist |
| 101Y00000X Counselor | |
| 101YM0800X Counselor, Mental Health | |
| 101YP2500X Counselor, Professional | |
| 102L00000X Psychoanalyst | |
| 103K00000X Behavior Analyst | |
| 103T00000X Psychologist | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| 103TC1900X Psychologist, Counseling | |
| Enumeration Date | 2022-12-22 |
| Last Update Date | 2022-12-22 |