| NPI | 1215401401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TF0200X Psychologist, Forensic (Licence: NC 5073) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NC 5073) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NC 5073) | |
| 103TC1900X Psychologist, Counseling (Licence: NC 5073) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-20592) | |
| 103T00000X Psychologist (Licence: NC 5073) | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: NC 5073) | |
| 103TE1100X Psychologist, Exercise & Sports (Licence: NC 5073) | |
| Enumeration Date | 2019-01-22 |
| Last Update Date | 2019-01-22 |