| NPI | 1720203334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 3222) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NC 3222) |
| 103TC0700X Psychologist Clinical (Licence: NC 3222) | |
| 103TC1900X Psychologist Counseling (Licence: NC 3222) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: NC 3222) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: NC 3222) | |
| 106H00000X Marriage & Family Therapist (Licence: NC 3222) | |
| 103TF0000X Psychologist Family (Licence: NC 3222) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: NC 3222) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: NC 3222) | |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2024-09-11 |