| NPI | 1043248800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY2338) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL PY2338) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2011-06-22 |