| NPI | 1679866875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 486) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NC 486) |
| 103TC0700X Psychologist, Clinical (Licence: NC 486) | |
| 103TC1900X Psychologist, Counseling (Licence: NC 486) | |
| 103TF0000X Psychologist, Family (Licence: NC 486) | |
| 103TH0100X Psychologist, Health Service (Licence: NC 486) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: NC 486) | |
| Enumeration Date | 2011-05-20 |
| Last Update Date | 2011-05-20 |