NPI | 1487892469 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: GA PSY003347) |
Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: GA PSY003347) |
103TB0200X Psychologist Cognitive & Behavioral (Licence: GA PSY003347) | |
103TC2200X Psychologist Clinical Child & Adolescent (Licence: GA PSY003347) | |
103TF0000X Psychologist Family (Licence: GA PSY003347) | |
103TP2701X Psychologist Group Psychotherapy (Licence: GA PSY003347) | |
Enumeration Date | 2009-01-28 |
Last Update Date | 2023-03-20 |