| NPI | 1134119126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: CO 1934) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CO 1934) |
| 103TC0700X Psychologist, Clinical (Licence: CO 1934) | |
| 103TC1900X Psychologist, Counseling (Licence: CO 1934) | |
| 103TF0000X Psychologist, Family (Licence: CO 1934) | |
| 103T00000X Psychologist (Licence: CO 1934) | |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2007-07-08 |