| 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 |