| NPI | 1255517884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: GA PSY003711) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 103T00000X Psychologist (Licence: MO 2011035787) | |
| Enumeration Date | 2008-01-14 |
| Last Update Date | 2016-04-26 |