| NPI | 1700339447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health | |
| 101YP2500X Counselor, Professional | |
| 103TC0700X Psychologist, Clinical (Licence: MD A0045) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103TF0000X Psychologist, Family | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| 103TR0400X Psychologist, Rehabilitation | |
| 103TS0200X Psychologist, School | |
| Enumeration Date | 2016-07-29 |
| Last Update Date | 2016-07-29 |