| NPI | 1760650626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NC 1024) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NC 1024) |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: NC 1024) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: NC 1024) | |
| 103TC1900X Psychologist Counseling (Licence: NC 1024) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: NC 1024) | |
| 103TF0000X Psychologist Family (Licence: NC 1024) | |
| 103TH0004X Psychologist Health (Licence: NC 1024) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: NC 1024) | |
| Enumeration Date | 2008-02-13 |
| Last Update Date | 2009-09-16 |