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 |