| NPI | 1144802265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist Counseling |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 102L00000X Psychoanalyst | |
| 103K00000X Behavior Analyst | |
| 103T00000X Psychologist | |
| 103TB0200X Psychologist Cognitive & Behavioral | |
| 103TC2200X Psychologist Clinical Child & Adolescent | |
| 103TP2701X Psychologist Group Psychotherapy | |
| Enumeration Date | 2021-04-27 |
| Last Update Date | 2021-04-27 |