NPI | 1326099821 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
103TC1900X Psychologist, Counseling | |
103TC2200X Psychologist, Clinical Child & Adolescent | |
Enumeration Date | 2006-05-12 |
Last Update Date | 2007-07-08 |