| NPI | 1942439666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: FL PY8017) |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: NY 8474) |
| Enumeration Date | 2009-07-02 |
| Last Update Date | 2011-12-05 |