NPI | 1568408284 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: CA PSY15581) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY15581) |
Enumeration Date | 2006-06-21 |
Last Update Date | 2007-07-08 |