| NPI | 1568609865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 1957) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: MA 1957) |
| Enumeration Date | 2009-01-08 |
| Last Update Date | 2009-01-08 |