| NPI | 1639297682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 897) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: MD 897) |
| 103TC0700X Psychologist, Clinical (Licence: MD 897) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MD 897) | |
| 103TE1100X Psychologist, Exercise & Sports (Licence: MD 897) | |
| 103TF0000X Psychologist, Family (Licence: MD 897) | |
| 103TF0200X Psychologist, Forensic (Licence: MD 897) | |
| 103TH0100X Psychologist, Health Service (Licence: MD 897) | |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2007-07-09 |