| NPI | 1336126507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: GA 0799) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: GA 799) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: GA 799) | |
| 103TC0700X Psychologist, Clinical (Licence: GA 799) | |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2009-04-24 |