| NPI | 1417057555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: WI 2383057) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WI 2383057) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2025-09-11 |