| NPI | 1770722530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist Cognitive & Behavioral (Licence: MA 8750) |
| Additional Taxonomies | 103TA0700X Psychologist Adult Development & Aging (Licence: MA 8750) |
| 103TC0700X Psychologist Clinical (Licence: MA 8750) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MA 8750) | |
| Enumeration Date | 2009-02-18 |
| Last Update Date | 2009-02-18 |