| NPI | 1750450292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MA 483) |
| Additional Taxonomies | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: MA 483) |
| 103T00000X Psychologist (Licence: MA 483) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: MA 483) | |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2025-09-11 |