| NPI | 1427274273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810007396) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: LA 614) |
| 103TH0004X Psychologist, Health (Licence: IL 071006511) | |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2021-12-15 |