| NPI | 1164805891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NH 932) |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: NH 932) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2015-06-30 |