| NPI | 1396784112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: MI 6301005370) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MI 6301005370) |
| 103T00000X Psychologist (Licence: MI 6301005370) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2007-07-08 |