| NPI | 1255380945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OK 1208) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: PA PS008789L) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: PA PS008789L) | |
| 103T00000X Psychologist (Licence: PA PS008789L) | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: OK 1208) | |
| 103TH0100X Psychologist, Health Service (Licence: OK 1208) | |
| 103TS0200X Psychologist, School (Licence: OK 1208) | |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2016-12-08 |