| NPI | 1942321989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TA0400X Psychologist Addiction (Substance Use Disorder) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: OH 4045) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2007-07-08 |