| NPI | 1225347974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: FL PY 8159) |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: FL PY 8159) |
| Enumeration Date | 2010-09-29 |
| Last Update Date | 2013-03-14 |