NPI | 1548496177 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810004358) |
Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: VA 0810004358) |
Enumeration Date | 2009-06-10 |
Last Update Date | 2011-08-16 |