| NPI | 1962524207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 2300) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: NC 2300) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NC 2300) | |
| 103TC0700X Psychologist, Clinical (Licence: NC 2300) | |
| 103TC1900X Psychologist, Counseling (Licence: NC 2300) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NC 2300) | |
| 103TH0100X Psychologist, Health Service (Licence: NC 2300) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: NC 2300) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: NC 2300) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: NC 2300) | |
| 103TS0200X Psychologist, School (Licence: NC 2300) | |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2018-03-17 |