| NPI | 1275696924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810002999) |
| Additional Taxonomies | 103TH0004X Psychologist, Health (Licence: AZ 3861) |
| 103TE1100X Psychologist, Exercise & Sports (Licence: AZ 3861) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: AZ 3861) | |
| 103G00000X Clinical Neuropsychologist (Licence: AZ 3861) | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: VA 0810002999) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: VA 0810002999) | |
| 103TF0000X Psychologist, Family (Licence: VA 0810002999) | |
| 103TF0200X Psychologist, Forensic (Licence: VA 0810002999) | |
| 103TH0100X Psychologist, Health Service (Licence: VA 0810002999) | |
| 103TH0100X Psychologist, Health Service (Licence: AZ 3861) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: VA 0810002999) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: VA 0810002999) | |
| 171000000X Military Health Care Provider (Licence: AZ 3861) | |
| 171W00000X Contractor (Licence: AZ 3861) | |
| Enumeration Date | 2006-12-17 |
| Last Update Date | 2008-12-31 |