| NPI | 1073964433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301016749) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: MI 6301016749) |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2017-03-09 |