| NPI | 1366752685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NY 018460-1) |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: CA PSY23261) |
| Enumeration Date | 2010-10-20 |
| Last Update Date | 2014-09-22 |