| NPI | 1780074807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral |
| 103TC1900X Psychologist Counseling | |
| 103TP2701X Psychologist Group Psychotherapy | |
| Enumeration Date | 2015-01-27 |
| Last Update Date | 2022-03-02 |