| NPI | 1447725809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AK 164185) |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: AK 164185) |
| 103TC0700X Psychologist Clinical (Licence: NY 022959) | |
| Enumeration Date | 2018-10-11 |
| Last Update Date | 2022-11-30 |