| NPI | 1497843163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 0911) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NC 911) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NC 911) | |
| 103T00000X Psychologist (Licence: NC 911) | |
| 103TF0000X Psychologist, Family (Licence: NC 911) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: NC 911) | |
| 103TF0200X Psychologist, Forensic (Licence: NC 911) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2012-03-19 |