| NPI | 1467552067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: CT 775) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CT 775) |
| Enumeration Date | 2006-09-23 |
| Last Update Date | 2007-07-08 |