| NPI | 1568704104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CT 003121) |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) |
| 103TC0700X Psychologist Clinical (Licence: CT 003121) | |
| Enumeration Date | 2013-03-21 |
| Last Update Date | 2013-03-21 |