| NPI | 1447611876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: PR 5846) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: PR 917) |
| Enumeration Date | 2016-03-12 |
| Last Update Date | 2017-05-08 |