| NPI | 1053436337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: HI PSY 499) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: HI PSY 499) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| 106H00000X Marriage & Family Therapist (Licence: HI PSY 499) | |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2019-09-09 |