| NPI | 1881955128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TF0000X Psychologist, Family |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities | |
| Enumeration Date | 2012-06-04 |
| Last Update Date | 2012-06-04 |