| NPI | 1477513182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 23079) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: TX 23079) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: TX 23079) | |
| 103T00000X Psychologist (Licence: TX 23079) | |
| Enumeration Date | 2006-03-25 |
| Last Update Date | 2007-07-13 |