| NPI | 1295974764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: AZ 3174) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: AZ 3174) |
| 103TF0000X Psychologist Family (Licence: AZ 3174) | |
| Enumeration Date | 2009-02-06 |
| Last Update Date | 2014-01-08 |