| NPI | 1881455830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
| 103TA0700X Psychologist, Adult Development & Aging | |
| Enumeration Date | 2024-01-17 |
| Last Update Date | 2024-01-17 |