| NPI | 1144294174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY 7397) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: FL PY 7397) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: FL PY 7397) | |
| 103TF0000X Psychologist, Family (Licence: FL PY 7397) | |
| 103TH0100X Psychologist, Health Service (Licence: FL PY 7397) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: FL PY 7397) | |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2018-03-13 |