| NPI | 1790427276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YP2500X Counselor, Professional | |
| 101YP2500X Counselor, Professional | |
| 101YS0200X Counselor, School | |
| Enumeration Date | 2022-04-13 |
| Last Update Date | 2022-04-13 |