| NPI | 1194892729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CO 1964) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: CO 1964) |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: CO 1964) | |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2007-07-08 |