| NPI | 1871806182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: SC 1149) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: SC 1149) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: SC 1149) | |
| 103TH0004X Psychologist, Health (Licence: SC 1149) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: SC 1149) | |
| Enumeration Date | 2010-07-16 |
| Last Update Date | 2013-08-02 |