| NPI | 1811137318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: UT 378080-2501) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: UT 378080-2501) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: UT 378080-2501) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: UT 378080-2501) | |
| 103TC1900X Psychologist, Counseling (Licence: UT 378080-2501) | |
| 103TF0200X Psychologist, Forensic (Licence: UT 378080-2501) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: UT 378080-2501) | |
| 103TS0200X Psychologist, School (Licence: UT 378080-2501) | |
| Enumeration Date | 2009-02-24 |
| Last Update Date | 2009-02-24 |