| NPI | 1194789297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: UT 117535-2501) |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: UT 117535-2501) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: UT 117535-2501) | |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2011-04-26 |