NPI | 1235404070 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PR 3500) |
Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: PR 3500) |
103TF0000X Psychologist, Family (Licence: PR 3500) | |
103TP2701X Psychologist, Group Psychotherapy (Licence: PR 3500) | |
Enumeration Date | 2012-03-13 |
Last Update Date | 2012-03-13 |