| NPI | 1790870590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: CO 4379) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO 2074) |
| 103T00000X Psychologist (Licence: CO 2074) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2007-07-08 |