| NPI | 1558351981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 1158) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NC 1158) | |
| 103TC0700X Psychologist, Clinical (Licence: NC 1158) | |
| 103TC1900X Psychologist, Counseling (Licence: NC 1158) | |
| 103TF0200X Psychologist, Forensic (Licence: NC 1158) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: NC 1158) | |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2010-10-14 |