NPI | 1740503150 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: UT 7369628-2501-2501) |
Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: UT 7369628-2501) |
103TC0700X Psychologist, Clinical (Licence: UT 7369628-2501) | |
103TC1900X Psychologist, Counseling (Licence: UT 7369628-2501) | |
103TH0100X Psychologist, Health Service (Licence: UT 2369628-2501) | |
Enumeration Date | 2010-03-12 |
Last Update Date | 2010-03-12 |