| NPI | 1891414918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSB94029549) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CT 1216) |
| 101YP2500X Counselor, Professional (Licence: CT 46.008556) | |
| 104100000X Social Worker (Licence: NJ 44SL07335300) | |
| Enumeration Date | 2022-08-23 |
| Last Update Date | 2026-04-07 |