| NPI | 1194498899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103TF0200X Psychologist, Forensic | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| 103TR0400X Psychologist, Rehabilitation | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2021-07-28 |
| Last Update Date | 2021-07-28 |