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, Intellectual & Developmental Disabilities | |
103TP2701X Psychologist, Group Psychotherapy | |
Enumeration Date | 2008-04-24 |
Last Update Date | 2008-04-24 |