| NPI | 1144305749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: ID PSY202134) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: ID PSY202134) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: ID PSY202134) | |
| 103TF0000X Psychologist Family (Licence: ID PSY202134) | |
| 103TP0814X Psychologist Psychoanalysis (Licence: ID PSY202134) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2017-12-13 |