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 |