| NPI | 1346465382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 2256) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: WI 2256) |
| 103TC1900X Psychologist, Counseling (Licence: WI 2256) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: WI 2256) | |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2007-07-08 |