| 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, Intellectual & Developmental Disabilities (Licence: NM 1248) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: NM 1248) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2018-04-02 |