| NPI | 1285756767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 03421) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MD 03421) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MD 03421) | |
| 103TF0000X Psychologist, Family (Licence: MD 03421) | |
| 103TP0814X Psychologist, Psychoanalysis (Licence: MD 03421) | |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2016-07-05 |