| NPI | 1578604500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CT 912) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: CT 912) |
| Enumeration Date | 2007-02-11 |
| Last Update Date | 2007-07-08 |