| NPI | 1104969385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY6891) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY6891) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: FL PY6891) | |
| 103TF0000X Psychologist, Family (Licence: FL PY6891) | |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2007-12-28 |