| NPI | 1396309076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 3678-57) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: WI 3678-57) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: WI 3678-57) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WI 3678-57) | |
| 103TF0200X Psychologist, Forensic (Licence: WI 3678-57) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: WI 3678-57) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: WI 3678-57) | |
| Enumeration Date | 2019-04-27 |
| Last Update Date | 2019-05-09 |