NPI | 1114967361 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: MI 63010M370) |
Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MI 63010M370) |
103TC0700X Psychologist, Clinical (Licence: MI 63010M370) | |
Enumeration Date | 2006-06-07 |
Last Update Date | 2007-07-08 |