| NPI | 1972591071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 103TC0700X Psychologist, Clinical (Licence: VA 0810004569) | |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2017-01-11 |