| NPI | 1013182559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NV PY0327) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA PSY14696) |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: NV PY0327) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: NV PY0327) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: CA PSY14696) | |
| 103TC0700X Psychologist Clinical (Licence: CA PSY14696) | |
| 103TF0200X Psychologist Forensic (Licence: NV PY0327) | |
| 103TF0200X Psychologist Forensic (Licence: CA PSY14696) | |
| 103TR0400X Psychologist Rehabilitation (Licence: NV PY0327) | |
| 103TR0400X Psychologist Rehabilitation (Licence: CA PSY14696) | |
| Enumeration Date | 2008-04-25 |
| Last Update Date | 2012-07-17 |