| NPI | 1386640159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TH0100X Psychologist, Health Service (Licence: MO 2009026793) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2001004284) |
| 106H00000X Marriage & Family Therapist (Licence: MO 2001004284) | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: MO 2009026793) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MO 2009026793) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: MO 2009026793) | |
| 103TC1900X Psychologist, Counseling (Licence: MO 2009026793) | |
| 103TC0700X Psychologist, Clinical (Licence: MO 2009026793) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MO 2009026793) | |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2011-04-21 |