| NPI | 1417093188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA PS015082) |
| 103T00000X Psychologist (Licence: PA PS015082) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2007-07-09 |