| NPI | 1093868077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MA 2003) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA 2003) |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: MA 2003) | |
| 103TA0700X Psychologist Adult Development & Aging (Licence: MA 2003) | |
| 103TC1900X Psychologist Counseling (Licence: MA 2003) | |
| 103TF0000X Psychologist Family (Licence: MA 2003) | |
| 103TH0100X Psychologist Health Service (Licence: MA 2003) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: MA 2003) | |
| 103TR0400X Psychologist Rehabilitation (Licence: MA 2003) | |
| Enumeration Date | 2007-01-21 |
| Last Update Date | 2015-04-02 |