| NPI | 1720339377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral |
| Additional Taxonomies | 102L00000X Psychoanalyst |
| 103TA0700X Psychologist, Adult Development & Aging | |
| 103TC1900X Psychologist, Counseling | |
| 103TF0000X Psychologist, Family | |
| 103TF0200X Psychologist, Forensic | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2012-09-23 |
| Last Update Date | 2012-09-23 |