| NPI | 1366554784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: PA PS008155L) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: PA PS008155L) |
| 103TC1900X Psychologist, Counseling (Licence: PA PS008155L) | |
| 103TF0000X Psychologist, Family (Licence: PA PS008155L) | |
| 103T00000X Psychologist (Licence: PA PS008155L) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2007-07-08 |