| NPI | 1861645889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801074762) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA RPS2008066) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: CA RA819095) | |
| Enumeration Date | 2008-11-04 |
| Last Update Date | 2008-11-04 |