NPI | 1609426618 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
103TF0000X Psychologist, Family | |
103TP2701X Psychologist, Group Psychotherapy | |
Enumeration Date | 2019-09-12 |
Last Update Date | 2019-12-02 |