| NPI | 1871605915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301012964) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: MI 200727) |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2007-07-26 |