| NPI | 1346309507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CT 000935) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CT 000935) |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: CT 000935) | |
| 103TS0200X Psychologist, School (Licence: CT 000935) | |
| 103TH0100X Psychologist, Health Service (Licence: CT 000935) | |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2012-09-19 |