| NPI | 1497964472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MA 4626) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: MA 4626) |
| 103TC0700X Psychologist Clinical (Licence: MA 4626) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MA 4626) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2021-07-23 |