| NPI | 1831211101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 1784) |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: WI 1784) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: WI 1784) | |
| 103TC0700X Psychologist Clinical (Licence: WI 1784) | |
| 103TC1900X Psychologist Counseling (Licence: WI 1784) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: WI 1784) | |
| 103TF0000X Psychologist Family (Licence: WI 1784) | |
| Enumeration Date | 2007-04-05 |
| Last Update Date | 2007-07-09 |