| NPI | 1568976561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: FL PY10667) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: FL IMH8938) |
| 103T00000X Psychologist (Licence: FL PY10667) | |
| 103T00000X Psychologist (Licence: MD 06586) | |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: MD 06586) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: FL PY10667) | |
| 103TC0700X Psychologist Clinical (Licence: MD 06586) | |
| 103TC1900X Psychologist Counseling (Licence: FL PY10667) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: FL PY10667) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MD 06586) | |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2017-11-29 |
| Last Update Date | 2021-04-17 |