| NPI | 1760520944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NH 133) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: NH AD003482) |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: NH 133) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NH 133) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NH 133) | |
| 103T00000X Psychologist (Licence: NH 133) | |
| 103TF0000X Psychologist, Family (Licence: NH 133) | |
| 103TH0100X Psychologist, Health Service (Licence: NH 133) | |
| 103TS0200X Psychologist, School (Licence: NH 22111) | |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2010-11-03 |