| NPI | 1003149576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY11082) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: MO 2009026784) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MO 2009026784) | |
| 103TC0700X Psychologist, Clinical (Licence: MO 2009026784) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: MO 2009026784) | |
| Enumeration Date | 2009-09-15 |
| Last Update Date | 2021-05-27 |