| NPI | 1295862530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: PR 1932) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PR 1932) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: PR 1932) | |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2007-07-08 |