| NPI | 1285897942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: PR 2919) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PR 0288) |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2008-07-03 |