| NPI | 1699946954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 2437) |
| Additional Taxonomies | 103TF0000X Psychologist, Family |
| 103TF0200X Psychologist, Forensic | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: NC 2437) | |
| 103T00000X Psychologist | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 103TE1100X Psychologist, Exercise & Sports | |
| Enumeration Date | 2008-03-14 |
| Last Update Date | 2016-04-19 |