| 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 |