| NPI | 1760978282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MA 3371) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: MA 3371) |
| Enumeration Date | 2018-07-09 |
| Last Update Date | 2018-07-09 |