| NPI | 1437434917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CT 3209) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CT 3209) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CT 3209) | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: CT 3209) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CT 3209) | |
| 103TF0000X Psychologist, Family (Licence: CT 3209) | |
| Enumeration Date | 2011-10-17 |
| Last Update Date | 2015-09-04 |