| NPI | 1013137447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 6807) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MA 6807) |
| 103T00000X Psychologist (Licence: MA 6807) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: MA 6807) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MA 6807) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: MA 6807) | |
| 106H00000X Marriage & Family Therapist (Licence: MA 6807) | |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2020-08-28 |