| NPI | 1023109469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS-004325L) |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: PA PS-004325L) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2007-10-09 |