| NPI | 1962627901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR 0935) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: OR 0935) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: OR 0935) | |
| 103TC0700X Psychologist, Clinical (Licence: OR 0935) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: OR 0935) | |
| 103TF0200X Psychologist, Forensic (Licence: OR 0935) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: OR 0935) | |
| 106H00000X Marriage & Family Therapist (Licence: OR 0935) | |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2007-07-08 |