| NPI | 1033619986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: KY 265760) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KY 265760) |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: KY 265760) | |
| Enumeration Date | 2018-02-16 |
| Last Update Date | 2024-03-12 |