| NPI | 1417102179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: LA 1165) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
| 103TF0000X Psychologist, Family | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| Enumeration Date | 2008-11-22 |
| Last Update Date | 2013-06-05 |