| NPI | 1629104641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 2262) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 2262) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NC 2262) | |
| 103TF0000X Psychologist, Family (Licence: NC 2262) | |
| 103TH0100X Psychologist, Health Service (Licence: NC 2262) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: NC 2262) | |
| 103TF0200X Psychologist, Forensic (Licence: NC 2262) | |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2010-04-19 |