| NPI | 1669588356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TA0700X Psychologist, Adult Development & Aging (Licence: OK 486) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OK 486) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: OK 486) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: OK 486) | |
| 103T00000X Psychologist (Licence: OK 486) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: OK 486) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: OK 486) | |
| 106H00000X Marriage & Family Therapist (Licence: OK 486) | |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2007-07-08 |