| NPI | 1356492532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent |
| 103TF0000X Psychologist, Family | |
| 103T00000X Psychologist | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities | |
| 103T00000X Psychologist (Licence: OR 0920) | |
| 103TC0700X Psychologist, Clinical (Licence: OR 0920) | |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2007-07-08 |