| NPI | 1124186986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA psychologist6705) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: MA psychologist6705) |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: MA psychologist6705) | |
| 103TC1900X Psychologist, Counseling (Licence: MA psychologist6705) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MA psychologist6705) | |
| 103TE1100X Psychologist, Exercise & Sports (Licence: MA psychologist6705) | |
| 103TF0000X Psychologist, Family (Licence: MA psychologist6705) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: MA psychologist6705) | |
| 103TS0200X Psychologist, School (Licence: MA psychologist6705) | |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2007-07-08 |