| NPI | 1518179282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TA0700X Psychologist, Adult Development & Aging (Licence: AZ LPC1432) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: AZ LPC1432) |
| 103TC0700X Psychologist, Clinical (Licence: AZ LPC1432) | |
| 103TC1900X Psychologist, Counseling (Licence: AZ LPC1432) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: AZ LPC1432) | |
| 103TF0000X Psychologist, Family (Licence: AZ LPC1432) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: AZ LPC1432) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: AZ LPC1432) | |
| 246ZE0500X Specialist/Technologist, Other, EEG (Licence: AZ LPC1432) | |
| 2472E0500X Technician, Other, EEG (Licence: AZ LPC1432) | |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2007-07-08 |