| NPI | 1740327733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 1056) |
| Additional Taxonomies | 103TF0000X Psychologist, Family (Licence: MD 1056) |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: MD 1056) | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2016-04-14 |