| NPI | 1558426999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WI 1480-057) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WI 1480-057) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 1480-057) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WI 1480-57) | |
| 103TF0200X Psychologist, Forensic (Licence: WI 1480-057) | |
| 103TH0100X Psychologist, Health Service (Licence: WI 1480-057) | |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2009-07-09 |