| NPI | 1487688859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 1285-057) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: WI 1285-057) |
| 103TC1900X Psychologist, Counseling (Licence: WI 1285-057) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2023-12-08 |