| NPI | 1851522817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY13237) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 1256) |
| 103TC0700X Psychologist, Clinical (Licence: PR 3411) | |
| Enumeration Date | 2009-08-06 |
| Last Update Date | 2026-09-15 |