NPI | 1518942770 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: WA PY00002607) |
Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: WA PY00002607) |
103TC0700X Psychologist, Clinical (Licence: WA PY00002607) | |
103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WA PY00002607) | |
103TH0100X Psychologist, Health Service (Licence: WA PY00002607) | |
103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: WA PY00002607) | |
103T00000X Psychologist (Licence: WA PY00002607) | |
103TP2701X Psychologist, Group Psychotherapy (Licence: WA PY00002607) | |
Enumeration Date | 2005-12-09 |
Last Update Date | 2022-07-21 |