| NPI | 1437363330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: SC 1002) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: SC 1002) |
| 103TF0000X Psychologist, Family (Licence: SC 1002) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: SC 1002) | |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2016-05-06 |