| NPI | 1437200763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: GA PSY000682) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: GA PSY000682) |
| 103TC1900X Psychologist Counseling (Licence: GA PSY000682) | |
| 103TC0700X Psychologist Clinical (Licence: GA PSY000682) | |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2012-02-24 |