| 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 |