| NPI | 1497755979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TN P0000000685) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MS 27365) |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: TN P0000000685) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: TN P0000000685) | |
| Enumeration Date | 2005-07-27 |
| Last Update Date | 2008-02-04 |