| NPI | 1407876378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CT 001293) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA 8086) |
| 103T00000X Psychologist (Licence: NY 005193-1) | |
| 106H00000X Marriage & Family Therapist (Licence: CT 000281) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2011-01-04 |