| NPI | 1083899231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: DC 1811) |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: DC 1811) |
| 103TA0700X Psychologist Adult Development & Aging (Licence: DC 1811) | |
| 103TC0700X Psychologist Clinical (Licence: MD 2430) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: DC 1811) | |
| Enumeration Date | 2008-01-07 |
| Last Update Date | 2008-01-07 |