| NPI | 1831230259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: UT 353104-2501) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: UT 353104-2501) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2014-07-30 |