| NPI | 1619106226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MD 06947) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: MD 06947) |
| 103TC0700X Psychologist Clinical (Licence: MD 06947) | |
| 103TC1900X Psychologist Counseling (Licence: MD 06947) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MD 06947) | |
| 103TF0000X Psychologist Family (Licence: MD 06947) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: MD 06947) | |
| 103TR0400X Psychologist Rehabilitation (Licence: MD 06947) | |
| 104100000X Social Worker (Licence: MD 06947) | |
| Enumeration Date | 2009-07-06 |
| Last Update Date | 2011-04-01 |