| NPI | 1730169202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY7448) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY7448) |
| 103TC1900X Psychologist, Counseling (Licence: FL PY7448) | |
| 103TF0000X Psychologist, Family (Licence: FL PY7448) | |
| 106H00000X Marriage & Family Therapist | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: FL PY7448) | |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2008-10-20 |