| NPI | 1245405844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: UT 5213616-2501) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: UT 5213616-2501) |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) | |
| 103TA0700X Psychologist Adult Development & Aging | |
| 103TB0200X Psychologist Cognitive & Behavioral | |
| 103TC2200X Psychologist Clinical Child & Adolescent | |
| 103TF0200X Psychologist Forensic | |
| 103TH0100X Psychologist Health Service | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities | |
| 103TP2701X Psychologist Group Psychotherapy | |
| Enumeration Date | 2008-04-24 |
| Last Update Date | 2008-04-24 |