| NPI | 1700170818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR 2162) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: OR 2162) |
| 103TC0700X Psychologist Clinical (Licence: OR 2162) | |
| 103TC1900X Psychologist Counseling (Licence: OR 2162) | |
| 103TF0000X Psychologist Family (Licence: OR 2162) | |
| 103TF0200X Psychologist Forensic (Licence: OR 2162) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: OR 2162) | |
| Enumeration Date | 2011-06-06 |
| Last Update Date | 2012-07-27 |