| NPI | 1063517324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: HI PSY-277) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: HI 532-92) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2011-07-29 |