| NPI | 1265573224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 2433) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 2433) |
| 103TF0000X Psychologist, Family (Licence: MA 2433) | |
| 106H00000X Marriage & Family Therapist (Licence: MA 2433) | |
| Enumeration Date | 2007-02-10 |
| Last Update Date | 2014-08-20 |