| NPI | 1316040256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MI 6301010808) |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: MI 6301010808) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2008-09-11 |