| NPI | 1710078068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NH 1533) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: MD 03296) |
| 103TC0700X Psychologist Clinical (Licence: MD 03296) | |
| 103TC1900X Psychologist Counseling (Licence: MD 03296) | |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2023-04-24 |