| NPI | 1528366689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CT 003214) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA 4835) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MA 4835) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CT 003214) | |
| 103TC0700X Psychologist, Clinical (Licence: MA 4835) | |
| 103TC0700X Psychologist, Clinical (Licence: CT 003214) | |
| 103TF0000X Psychologist, Family (Licence: MA 4835) | |
| 103TF0000X Psychologist, Family (Licence: CT 003214) | |
| 103TH0004X Psychologist, Health (Licence: CT 003214) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: MA 4835) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: CT 003214) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: CT 003214) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: CT 003214) | |
| 103TS0200X Psychologist, School (Licence: MA 4835) | |
| 103TS0200X Psychologist, School (Licence: CT 003214) | |
| Enumeration Date | 2011-03-14 |
| Last Update Date | 2013-03-13 |