| NPI | 1659495885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 01730) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MD 01730) |
| 103T00000X Psychologist (Licence: DC 1000523) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: DC 1000523) | |
| 103TF0000X Psychologist Family (Licence: DC 1000523) | |
| 103TF0000X Psychologist Family (Licence: MD 01730) | |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2012-01-03 |