| NPI | 1053452078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810001126) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: VA 0810001126) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: VA 0810001126) | |
| Enumeration Date | 2007-02-11 |
| Last Update Date | 2023-11-10 |