| NPI | 1003341975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NM 0844) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NM 0844) |
| 103TC1900X Psychologist, Counseling (Licence: NM 0844) | |
| 103TF0000X Psychologist, Family (Licence: NM 0844) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: NM 0844) | |
| Enumeration Date | 2017-04-27 |
| Last Update Date | 2017-04-27 |