| NPI | 1881026342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: PR 4827) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: PR 4827) |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: PR 4827) | |
| 103TA0700X Psychologist Adult Development & Aging (Licence: PR 4827) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: PR 4827) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: PR 4827) | |
| 103TF0000X Psychologist Family (Licence: PR 4827) | |
| 103TF0200X Psychologist Forensic (Licence: PR 4827) | |
| 103TH0004X Psychologist Health (Licence: PR 4827) | |
| 103TH0100X Psychologist Health Service (Licence: PR 4827) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: PR 4827) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: PR 4827) | |
| 103TR0400X Psychologist Rehabilitation (Licence: PR 4827) | |
| 103TS0200X Psychologist School (Licence: PR 4827) | |
| 106H00000X Marriage & Family Therapist (Licence: PR 4827) | |
| Enumeration Date | 2013-08-06 |
| Last Update Date | 2013-08-06 |