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 |