| NPI | 1376633941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: NH 1269) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: AR 06-04P) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2013-05-29 |