| NPI | 1992404727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PR 7555) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: 7555) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: PR 7555) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: PR 7555) | |
| Enumeration Date | 2023-03-01 |
| Last Update Date | 2023-04-27 |