| NPI | 1356301295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 3037) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2014-05-22 |