| NPI | 1235466400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MI 6301014303) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: MI 6301014303) |
| Enumeration Date | 2009-11-10 |
| Last Update Date | 2013-03-07 |