| NPI | 1003194564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY 60153263) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: OR 1297) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: WA PY 60153263) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: OR 1297) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: WA PY 60153263) | |
| 103TA0700X Psychologist Adult Development & Aging (Licence: OR 1297) | |
| 103T00000X Psychologist (Licence: OR 1297) | |
| 103TC0700X Psychologist Clinical (Licence: OR 1297) | |
| 103TC0700X Psychologist Clinical (Licence: WA PY 60153263) | |
| 103TC1900X Psychologist Counseling (Licence: OR 1297) | |
| 103TC1900X Psychologist Counseling (Licence: WA PY 60153263) | |
| 103TF0000X Psychologist Family (Licence: OR 1297) | |
| 103TF0000X Psychologist Family (Licence: WA PY 60153263) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: OR 1297) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: WA PY 60153263) | |
| Enumeration Date | 2011-08-01 |
| Last Update Date | 2011-08-02 |