NPI | 1871774240 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO 3157) |
Additional Taxonomies | 103TH0004X Psychologist, Health (Licence: CO 3157) |
103TB0200X Psychologist, Cognitive & Behavioral (Licence: CO 3157) | |
103TP2701X Psychologist, Group Psychotherapy (Licence: CO 3157) | |
Enumeration Date | 2007-11-14 |
Last Update Date | 2024-05-30 |