| NPI | 1891725974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: HI 1178-03P) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: HI PSY-674) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: HI Psy-674) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: HI Psy-674) | |
| 103TC0700X Psychologist, Clinical (Licence: HI Psy-674) | |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2007-07-09 |