| NPI | 1043201239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PR 1306) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: DC 10065) |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2016-03-16 |