| NPI | 1659352672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MA 4071PR) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 4071PR) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MA 4071PR) | |
| 103TH0100X Psychologist, Health Service (Licence: MA 4071PR) | |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2007-07-10 |