| NPI | 1174566855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: AL 1408) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: AL 1408) | |
| 103TF0000X Psychologist Family (Licence: AL 1408) | |
| 103TR0400X Psychologist Rehabilitation (Licence: AL 1408) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: AL 1408) | |
| 106H00000X Marriage & Family Therapist (Licence: AL 1408) | |
| 101YP1600X Counselor Pastoral (Licence: AL 1408) | |
| 103TH0004X Psychologist Health (Licence: AL 1408) | |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2012-08-27 |