| NPI | 1336236173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 4663) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MA 4663) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MA 4663) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MA 4663) | |
| 103TF0000X Psychologist, Family (Licence: MA 4663) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2018-02-14 |