| NPI | 1871503631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: VA 0810001007) |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: VA 0810001007) |
| 103TA0700X Psychologist Adult Development & Aging (Licence: VA 0810001007) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: VA 0810001007) | |
| 103TC0700X Psychologist Clinical (Licence: VA 0810001007) | |
| 103TC1900X Psychologist Counseling (Licence: VA 0810001007) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: VA 0810001007) | |
| 103TF0000X Psychologist Family (Licence: VA 0810001007) | |
| 103TH0100X Psychologist Health Service (Licence: VA 0810001007) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: VA 0810001007) | |
| 106H00000X Marriage & Family Therapist (Licence: VA 0810001007) | |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2008-10-03 |