| NPI | 1033209986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 0639) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MD 639) |
| 103T00000X Psychologist (Licence: MD 639) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: MD 639) | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: MD 639) | |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2007-07-08 |