| NPI | 1720201759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: NM 0889) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NM 0889) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2007-07-08 |