| NPI | 1639220494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NH 466) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: MA 4330) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: NH 466) | |
| 103TC0700X Psychologist Clinical (Licence: MA 4330) | |
| 103TC0700X Psychologist Clinical (Licence: NH 466) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MA 4330) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: NH 466) | |
| 103TF0000X Psychologist Family (Licence: MA 4330) | |
| 103TF0000X Psychologist Family (Licence: NH 466) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: MA 4330) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: NH 466) | |
| 103T00000X Psychologist (Licence: MA 4330) | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2007-07-08 |