| NPI | 1588771547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 4737) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 4737) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MA 4737) | |
| 106H00000X Marriage & Family Therapist (Licence: MA 4737) | |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2015-03-20 |