| NPI | 1184845117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 1244) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MD 1244) |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: MD 1244) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2007-12-05 |