| NPI | 1871652248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WY 448) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OK 965) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: OK 965) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: OK 965) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WY 448) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: WY 448) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: WY 448) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: WY 448) | |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2007-09-10 |