| NPI | 1851949879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TM1800X Psychologist, Intellectual & Developmental Disabilities |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 102X00000X Poetry Therapist | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| Enumeration Date | 2019-09-03 |
| Last Update Date | 2019-09-03 |