| NPI | 1467623157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CT 003151) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: CT 3151) |
| 261QP3300X Clinic/Center, Pain (Licence: CT 003151) | |
| Enumeration Date | 2008-03-20 |
| Last Update Date | 2020-10-28 |