| NPI | 1912419284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PR 5921) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: PR 5921) |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: PR 5921) | |
| Enumeration Date | 2017-10-26 |
| Last Update Date | 2019-06-20 |