| NPI | 1609918564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 2939) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NC 2939) |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: NC 2939) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2014-07-31 |