| NPI | 1073782884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ 3660) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: AZ 3660) |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: AZ 3660) | |
| 103T00000X Psychologist (Licence: AZ 3660) | |
| Enumeration Date | 2008-02-26 |
| Last Update Date | 2021-04-29 |