| NPI | 1487902110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PR 2607) |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: PR 2607) |
| Enumeration Date | 2012-08-28 |
| Last Update Date | 2012-08-28 |