| NPI | 1033149984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: MA 3696) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MA 3696) |
| 103TC0700X Psychologist, Clinical (Licence: MA 3696) | |
| 103TC1900X Psychologist, Counseling (Licence: MA 3696) | |
| 103TF0000X Psychologist, Family (Licence: MA 3696) | |
| 103TF0200X Psychologist, Forensic (Licence: MA 3696) | |
| 103T00000X Psychologist (Licence: MA 3696) | |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2007-07-08 |