| NPI | 1386980290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 4582) |
| Additional Taxonomies | 103TF0000X Psychologist, Family |
| 102L00000X Psychoanalyst | |
| 103T00000X Psychologist | |
| 103TC1900X Psychologist, Counseling | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| Enumeration Date | 2012-12-20 |
| Last Update Date | 2019-03-14 |