| NPI | 1063775740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: HI 1523) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103T00000X Psychologist | |
| 103T00000X Psychologist (Licence: HI 1523) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: HI 1523) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: HI 1523) | |
| 103TF0000X Psychologist, Family (Licence: HI 1523) | |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2015-04-13 |