| NPI | 1801153309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 4783-125) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: 4783-125) |
| 103T00000X Psychologist (Licence: WI 4783-125) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: WI 4783-125) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WI 4783-125) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: WI 4783-125) | |
| 106H00000X Marriage & Family Therapist (Licence: WI 4783-125) | |
| Enumeration Date | 2012-04-20 |
| Last Update Date | 2012-04-20 |