| NPI | 1508921297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TA0700X Psychologist, Adult Development & Aging (Licence: MA 33) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MA 33) |
| 103TC0700X Psychologist, Clinical (Licence: MA 33) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MA 33) | |
| 103TF0000X Psychologist, Family (Licence: MA 33) | |
| 103T00000X Psychologist (Licence: MA 33) | |
| 103TS0200X Psychologist, School (Licence: MA 33) | |
| Enumeration Date | 2006-12-25 |
| Last Update Date | 2007-07-08 |