| NPI | 1902855547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: FL PY7305) |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: FL PY7305) |
| 103TA0700X Psychologist Adult Development & Aging (Licence: FL PY7305) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: FL PY7305) | |
| 103T00000X Psychologist (Licence: FL PY7305) | |
| 103TC1900X Psychologist Counseling (Licence: FL PY7305) | |
| 103TF0000X Psychologist Family (Licence: FL PY7305) | |
| 103TH0100X Psychologist Health Service (Licence: FL PY7305) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: FL PY7305) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: FL PY7305) | |
| 103TR0400X Psychologist Rehabilitation (Licence: FL PY7305) | |
| 103TH0004X Psychologist Health (Licence: FL PY7305) | |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2011-06-27 |