| NPI | 1689630279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OK 375) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: OK 375) |
| 103TC0700X Psychologist Clinical (Licence: OK 375) | |
| 103TC1900X Psychologist Counseling (Licence: OK 375) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: OK 375) | |
| 103TF0000X Psychologist Family (Licence: OK 375) | |
| 103TP0814X Psychologist Psychoanalysis (Licence: OK 375) | |
| Enumeration Date | 2006-04-24 |
| Last Update Date | 2007-07-08 |