| NPI | 1083625263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: FL PY4639) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY4639) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: FL PY4639) | |
| 103TF0000X Psychologist, Family (Licence: FL PY4639) | |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2007-07-08 |