| NPI | 1134633498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ PSY-004977) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NM 1485) |
| 103TC1900X Psychologist, Counseling (Licence: CO 21343) | |
| 103TC1900X Psychologist, Counseling (Licence: AZ 21343) | |
| 103TC1900X Psychologist, Counseling (Licence: FL 21343) | |
| 103TC1900X Psychologist, Counseling (Licence: ID 21343) | |
| 103TC1900X Psychologist, Counseling (Licence: NV 21343) | |
| 103TC1900X Psychologist, Counseling (Licence: WI 21343) | |
| 103TC1900X Psychologist, Counseling (Licence: UT 21343) | |
| 103TC1900X Psychologist, Counseling (Licence: TX 21343) | |
| 103TC1900X Psychologist, Counseling (Licence: WA 21343) | |
| Enumeration Date | 2017-11-24 |
| Last Update Date | 2025-07-21 |