| NPI | 1639232283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AL 921) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: AL 921) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: AL 921) | |
| 103TC0700X Psychologist, Clinical (Licence: AL 921) | |
| 103TC1900X Psychologist, Counseling (Licence: AL 921) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: AL 921) | |
| 103TF0000X Psychologist, Family (Licence: AL 921) | |
| 103TF0200X Psychologist, Forensic (Licence: AL 921) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: AL 921) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: AL 921) | |
| 106H00000X Marriage & Family Therapist (Licence: AL L7) | |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2008-04-29 |