| NPI | 1154040293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: SC 1542) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: SC 1542) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: SC 1542) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: SC 1542) | |
| 103TF0000X Psychologist, Family (Licence: SC 1542) | |
| Enumeration Date | 2022-08-23 |
| Last Update Date | 2022-08-23 |