| NPI | 1174857098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WA PY00000708) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) | |
| 103TB0200X Psychologist Cognitive & Behavioral | |
| 103TC1900X Psychologist Counseling | |
| 103TC2200X Psychologist Clinical Child & Adolescent | |
| 103TF0000X Psychologist Family | |
| 103TH0004X Psychologist Health | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities | |
| 103TP0814X Psychologist Psychoanalysis | |
| 103TP2701X Psychologist Group Psychotherapy | |
| 103TR0400X Psychologist Rehabilitation | |
| Enumeration Date | 2009-09-24 |
| Last Update Date | 2009-09-24 |