| NPI | 1770133548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NC 5606) |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) |
| 103TB0200X Psychologist Cognitive & Behavioral | |
| 103TR0400X Psychologist Rehabilitation | |
| Enumeration Date | 2019-09-13 |
| Last Update Date | 2024-08-15 |