| NPI | 1265951784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: AR 15-16P) |
| Additional Taxonomies | 103TP2701X Psychologist Group Psychotherapy (Licence: AR 15-16P) |
| 103TS0200X Psychologist School (Licence: AR 15-16P) | |
| 103T00000X Psychologist (Licence: AR 15-16P) | |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: AR 15-16P) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: AR 15-16P) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: AR 15-16P) | |
| 103TF0000X Psychologist Family (Licence: AR 15-16P) | |
| 103TH0004X Psychologist Health (Licence: AR 15-16P) | |
| Enumeration Date | 2017-09-15 |
| Last Update Date | 2017-09-15 |