| NPI | 1770729527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MA 2764) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA 2764) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: MA 2764) | |
| Enumeration Date | 2008-12-29 |
| Last Update Date | 2008-12-29 |