| NPI | 1780072009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO 1623) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: CO 1623) |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: CO 1623) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CO 1623) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CO 1623) | |
| 103TF0000X Psychologist, Family (Licence: CO 1623) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: CO 0393393) | |
| 103TS0200X Psychologist, School (Licence: CO 0393393) | |
| Enumeration Date | 2015-01-09 |
| Last Update Date | 2015-01-09 |