| NPI | 1346590908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CT 001688) |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: CT 001688) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: CT 001688) | |
| 103TC0700X Psychologist Clinical (Licence: CT 001688) | |
| 103TC1900X Psychologist Counseling (Licence: CT 001688) | |
| Enumeration Date | 2012-09-11 |
| Last Update Date | 2012-09-11 |