| NPI | 1417009937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NC 1010) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NC 1010) | |
| 106H00000X Marriage & Family Therapist (Licence: NC 283) | |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2019-01-30 |