| NPI | 1497841332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AZ 1400) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: AZ 1400) |
| 103TC1900X Psychologist, Counseling (Licence: AZ 1400) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: AZ 1400) | |
| 103TF0000X Psychologist, Family (Licence: AZ 1400) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2009-05-06 |