| NPI | 1932888740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral |
| Additional Taxonomies | 103TP2701X Psychologist, Group Psychotherapy |
| 101YM0800X Counselor, Mental Health | |
| 103T00000X Psychologist | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2023-07-18 |
| Last Update Date | 2025-02-14 |