| NPI | 1679823116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CT 001886) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral |
| 103TC1900X Psychologist Counseling | |
| 103TF0200X Psychologist Forensic (Licence: CT 001886) | |
| 103TP2701X Psychologist Group Psychotherapy | |
| Enumeration Date | 2012-09-12 |
| Last Update Date | 2012-09-12 |