| NPI | 1164825709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| Enumeration Date | 2014-09-26 |
| Last Update Date | 2018-12-28 |