NPI | 1477658763 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: CO 1245) |
Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: CO 5977) |
Enumeration Date | 2006-09-13 |
Last Update Date | 2013-04-05 |