| NPI | 1144351586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TP0016X Psychologist Prescribing (Medical) (Licence: NM 0037) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NM 1248) |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: NM 1248) | |
| 103TA0700X Psychologist Adult Development & Aging (Licence: NM 1248) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: NM 1248) | |
| 103TC0700X Psychologist Clinical (Licence: NM 1248) | |
| 103TC1900X Psychologist Counseling (Licence: NM 1248) | |
| 103TE1100X Psychologist Exercise & Sports (Licence: NM 1248) | |
| 103TF0000X Psychologist Family (Licence: NM 1248) | |
| 103TF0200X Psychologist Forensic (Licence: NM 1248) | |
| 103TH0004X Psychologist Health (Licence: NM 1248) | |
| 103TH0100X Psychologist Health Service (Licence: NM 1248) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: NM 1248) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: NM 1248) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2018-04-02 |