| NPI | 1720146194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MA 4228) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 4228) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MA 4228) | |
| 103TF0000X Psychologist, Family (Licence: MA 4228) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: MA 4228) | |
| 103T00000X Psychologist (Licence: MA 4228) | |
| 103TS0200X Psychologist, School (Licence: MA 4228) | |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2007-07-08 |