| NPI | 1831220912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: MA 2647) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 2647) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MA 2647) | |
| 103TF0200X Psychologist, Forensic (Licence: MA 2647) | |
| 103TH0100X Psychologist, Health Service (Licence: MA 2647) | |
| 103T00000X Psychologist (Licence: MA 2647) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: MA 2647) | |
| 103TS0200X Psychologist, School (Licence: MA 2647) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2007-07-08 |