| NPI | 1740503150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: UT 7369628-2501-2501) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: UT 7369628-2501) |
| 103TC0700X Psychologist, Clinical (Licence: UT 7369628-2501) | |
| 103TC1900X Psychologist, Counseling (Licence: UT 7369628-2501) | |
| 103TH0100X Psychologist, Health Service (Licence: UT 2369628-2501) | |
| Enumeration Date | 2010-03-12 |
| Last Update Date | 2010-03-12 |