| NPI | 1043270721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NC 2119) |
| Additional Taxonomies | 103TF0000X Psychologist Family (Licence: NC 2119) |
| 103TH0100X Psychologist Health Service (Licence: NC 2119) | |
| 103T00000X Psychologist (Licence: NC 2119) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: NC 2119) | |
| Enumeration Date | 2006-03-25 |
| Last Update Date | 2007-07-08 |