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 |