| NPI | 1104849215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: SC 831) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: GA PSY002223) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: GA PSY002223) | |
| 103TF0000X Psychologist, Family (Licence: GA PSY002223) | |
| 103T00000X Psychologist (Licence: GA PSY002223) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2009-12-01 |