| NPI | 1265844831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AZ PSY-005043) |
| Additional Taxonomies | 103T00000X Psychologist |
| 101YM0800X Counselor, Mental Health (Licence: OR R4311) | |
| 103TC0700X Psychologist, Clinical (Licence: AZ 005043) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: AZ 005043) | |
| Enumeration Date | 2014-05-29 |
| Last Update Date | 2023-02-19 |