| 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 |