NPI | 1770817025 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TF0200X Psychologist, Forensic |
Additional Taxonomies | 101Y00000X Counselor |
101YM0800X Counselor, Mental Health | |
101YP1600X Counselor, Pastoral | |
103TB0200X Psychologist, Cognitive & Behavioral | |
103TC1900X Psychologist, Counseling | |
103TF0200X Psychologist, Forensic (Licence: CO NLC448 DOC Approved) | |
103TP2701X Psychologist, Group Psychotherapy | |
Enumeration Date | 2009-09-18 |
Last Update Date | 2009-09-18 |