| NPI | 1689881062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TF0000X Psychologist, Family (Licence: DC PSY1574) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: VA 0810001350) |
| 103T00000X Psychologist (Licence: DC PSY1574) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: VA 0810001350) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: DC PSY1574) | |
| 103TC0700X Psychologist, Clinical (Licence: VA 0810001350) | |
| 103TC0700X Psychologist, Clinical (Licence: DC PSY1574) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: VA 0810001350) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: DC PSY1574) | |
| 103TF0000X Psychologist, Family (Licence: VA 0810001350) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2025-09-11 |