| NPI | 1326013855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: GA 1477) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: GA PSY0001477) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: GA PSY0001477) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: GA PSY0001477) | |
| Enumeration Date | 2006-02-20 |
| Last Update Date | 2021-04-06 |