| NPI | 1356542872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 02536) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2010-07-07 |