| NPI | 1033139563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 2191) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: MA 2191) |
| 103TH0100X Psychologist, Health Service (Licence: MA 2191) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2010-08-26 |