| NPI | 1326190083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: CO 2679) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CO 2679) |
| 103TC0700X Psychologist, Clinical (Licence: CO 2679) | |
| 103TF0200X Psychologist, Forensic (Licence: CO 2679) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: CO 2679) | |
| 103T00000X Psychologist (Licence: CO 2679) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: CO 2679) | |
| 103TS0200X Psychologist, School (Licence: CO 2679) | |
| 106H00000X Marriage & Family Therapist (Licence: CO 2679) | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2007-07-08 |