| NPI | 1093995177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: LA 991) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: LA 991) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: LA 991) | |
| 103TC0700X Psychologist, Clinical (Licence: LA 991) | |
| 103TF0000X Psychologist, Family (Licence: LA 991) | |
| 103TS0200X Psychologist, School (Licence: LA 991) | |
| Enumeration Date | 2007-11-06 |
| Last Update Date | 2023-09-11 |