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 |