| NPI | 1063586253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 541) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
| 103TC1900X Psychologist, Counseling | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: NC 541) | |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2017-08-15 |