| NPI | 1205266384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: HI 1336) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: HI 1336) |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: HI 1336) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: HI 1336) | |
| 103TE1100X Psychologist, Exercise & Sports (Licence: HI 1336) | |
| 103TF0000X Psychologist, Family | |
| 103TH0004X Psychologist, Health (Licence: HI 1336) | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| 103TR0400X Psychologist, Rehabilitation (Licence: HI 1336) | |
| Enumeration Date | 2013-11-26 |
| Last Update Date | 2017-02-01 |