| NPI | 1649221896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist Cognitive & Behavioral (Licence: NC 3064) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NC 3064) |
| 103TC1900X Psychologist Counseling (Licence: NC 3064) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: NC 3064) | |
| 103TF0000X Psychologist Family (Licence: NC 3064) | |
| 103T00000X Psychologist (Licence: NC 3064) | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2007-07-08 |