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 |