| NPI | 1952480725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 05394) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LC2181) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2024-04-18 |