| NPI | 1083732200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY5649) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY5649) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: FL PY5649) | |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2020-10-16 |