| NPI | 1194953877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD G12898) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MD G12898) |
| 103TC0700X Psychologist, Clinical (Licence: MD G12898) | |
| 103TC1900X Psychologist, Counseling (Licence: MD G12898) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MD G12898) | |
| 103TF0000X Psychologist, Family (Licence: MD G12898) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: MD G12898) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: MD G12898) | |
| 104100000X Social Worker (Licence: MD G12898) | |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2009-07-01 |