| NPI | 1750414843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: DC PSY 1351) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: DC PSY 1351) |
| 103TP2701X Psychologist Group Psychotherapy (Licence: DC PSY 1351) | |
| 103T00000X Psychologist (Licence: DC PSY1351) | |
| 103TC0700X Psychologist Clinical | |
| 103T00000X Psychologist | |
| 103TP2701X Psychologist Group Psychotherapy | |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2007-07-08 |