| NPI | 1386620466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: RI PS00787) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: RI PS00787) |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2007-07-08 |