| NPI | 1174576540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 1032) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: NC 1032) |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: NC 1032) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NC 1032) | |
| 103TC0700X Psychologist, Clinical (Licence: NC 1032) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NC 1032) | |
| 103TF0000X Psychologist, Family (Licence: NC 1032) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2007-08-29 |