| NPI | 1740496371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MA PY 4632-PR) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA PY 4632-PR) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MA PY 4632-PR) | |
| 103TF0000X Psychologist, Family (Licence: MA PY 4632-PR) | |
| 103TF0200X Psychologist, Forensic (Licence: MA PY 4632-PR) | |
| 103TS0200X Psychologist, School (Licence: MA PY 4632-PR) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2007-07-08 |