| 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 Mental Retardation & Developmental Disabilities (Licence: MA 4835) | |
| 103TM1800X Psychologist Mental Retardation & 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 |