| NPI | 1013040013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 00617) |
| Additional Taxonomies | 103TA0700X Psychologist Adult Development & Aging (Licence: MD 00617) |
| 103TC0700X Psychologist Clinical (Licence: MD 00617) | |
| 103TF0000X Psychologist Family (Licence: MD 00617) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: MD 00617) | |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2007-07-08 |