| NPI | 1861584690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2007-07-08 |