NPI | 1770811721 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810002691) |
Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: VA 0810002691) |
103TF0000X Psychologist, Family (Licence: VA 0810002691) | |
103TH0004X Psychologist, Health (Licence: VA 0810002691) | |
103TP2701X Psychologist, Group Psychotherapy (Licence: VA 0810002691) | |
103TR0400X Psychologist, Rehabilitation (Licence: VA 0810002691) | |
Enumeration Date | 2009-12-03 |
Last Update Date | 2015-02-12 |