| NPI | 1114967361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MI 63010M370) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: MI 63010M370) |
| 103TC0700X Psychologist, Clinical (Licence: MI 63010M370) | |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2025-09-11 |