| NPI | 1497229009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA LMHC10001385) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: PR 6268) |
| 103TF0000X Psychologist, Family (Licence: PR 6268) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: PR 6268) | |
| 103TS0200X Psychologist, School (Licence: PR 6268) | |
| 101Y00000X Counselor (Licence: MA LMHC10001385) | |
| 103T00000X Psychologist (Licence: PR 6268) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: PR 6268) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: PR 6268) | |
| 103TC0700X Psychologist, Clinical (Licence: PR 6268) | |
| Enumeration Date | 2019-01-16 |
| Last Update Date | 2023-12-13 |