| NPI | 1730370032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 8807) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: MA 8807) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MA 8807) | |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2008-01-07 |