| NPI | 1548771611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MS 581010) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: MS 581010) |
| Enumeration Date | 2017-10-17 |
| Last Update Date | 2022-06-07 |