| NPI | 1912069543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TF0000X Psychologist, Family (Licence: TX 25481) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: TX 25481) |
| 103TC0700X Psychologist, Clinical (Licence: TX 25481) | |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2025-09-11 |