| NPI | 1164544557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TA0700X Psychologist, Adult Development & Aging (Licence: PA PS000714L) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA PS000714L) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: PA PS000714L) | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: PA PS000714L) | |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2007-07-13 |