| NPI | 1750816575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 05765) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MD 05765) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MD 05765) | |
| 103TF0000X Psychologist, Family (Licence: MD 05765) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: MD 05765) | |
| Enumeration Date | 2017-04-30 |
| Last Update Date | 2017-04-30 |