| NPI | 1023120276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IA 00314) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: IA 00314) |
| 103TC1900X Psychologist, Counseling (Licence: IA 00772) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: IA 00314) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2023-11-10 |