| NPI | 1003064908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ 1396) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: AZ 1396) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2008-09-04 |