| NPI | 1427676840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: CA 94025433) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA 94025433) | |
| 103TC0700X Psychologist, Clinical (Licence: CA 94025433) | |
| Enumeration Date | 2020-07-13 |
| Last Update Date | 2022-02-28 |