| NPI | 1366585226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NV PY0264) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV LADC 00248-L) |
| 103TC0700X Psychologist, Clinical (Licence: CA 13587) | |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2010-11-10 |