| NPI | 1487745402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: IA 00550) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IA 00550) |
| 103TH0100X Psychologist, Health Service (Licence: IA 00166) | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: IA 00550) | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2015-03-07 |