| NPI | 1578713863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 04670) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MD 04670) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MD 04670) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: MD 04670) | |
| Enumeration Date | 2008-09-24 |
| Last Update Date | 2013-07-01 |