| NPI | 1447394275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: DC 1001023) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 101YM0800X Counselor, Mental Health | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MD 05540) | |
| 103TF0000X Psychologist, Family (Licence: MD 05540) | |
| 103TF0000X Psychologist, Family (Licence: DC 1001023) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MD 05540) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: DC 1001023) | |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2014-10-07 |