| NPI | 1629120340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: GA PSY002634) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: GA PSY002634) |
| 103TC0700X Psychologist, Clinical (Licence: GA PSY002634) | |
| 103TC1900X Psychologist, Counseling (Licence: GA PSY002634) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: GA PSY002634) | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2007-07-08 |