| NPI | 1710215520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TH0100X Psychologist, Health Service (Licence: MA PY9127-PR) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MA PY9127-PR) |
| 103TP2701X Psychologist, Group Psychotherapy | |
| Enumeration Date | 2009-12-07 |
| Last Update Date | 2024-10-10 |