| NPI | 1710158928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MI 002202) |
| Additional Taxonomies | 102L00000X Psychoanalyst (Licence: MI 002202) |
| 103TA0700X Psychologist Adult Development & Aging (Licence: MI 002202) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: MI 002202) | |
| 103TC1900X Psychologist Counseling (Licence: MI 002202) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MI 002202) | |
| 103TF0000X Psychologist Family (Licence: MI 002202) | |
| Enumeration Date | 2008-03-14 |
| Last Update Date | 2008-03-14 |