| NPI | 1710430137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ PSY-005364) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: AZ PSY-005364) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: AZ PSY-005364) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: AZ PSY-005364) | |
| Enumeration Date | 2016-08-02 |
| Last Update Date | 2024-01-11 |