NPI | 1235404724 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY8491) |
Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: FL PY8491) |
103T00000X Psychologist (Licence: FL PY# 8491) | |
103TB0200X Psychologist, Cognitive & Behavioral (Licence: FL PY8491) | |
Enumeration Date | 2012-03-15 |
Last Update Date | 2025-05-18 |