| NPI | 1316083553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: NY 007145-1) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: NJ SI 00290200) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2007-07-08 |