| NPI | 1346219904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO PY01874) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent |
| 103TF0000X Psychologist, Family | |
| 103TH0100X Psychologist, Health Service | |
| 103T00000X Psychologist | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2007-07-08 |