| NPI | 1326181934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MA 149) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MA 149) |
| 103TA0700X Psychologist Adult Development & Aging (Licence: MA 149) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: MA 149) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MA 149) | |
| 103TF0000X Psychologist Family (Licence: MA 149) | |
| 103T00000X Psychologist (Licence: MA 149) | |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2008-02-26 |