NPI | 1033675145 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: RI PS01682) |
Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) |
103TB0200X Psychologist Cognitive & Behavioral | |
Enumeration Date | 2019-02-13 |
Last Update Date | 2019-02-13 |