| NPI | 1780909820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: 3052) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: CO 3052) |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: CO 3052) | |
| 103TS0200X Psychologist, School (Licence: CO 0441416) | |
| Enumeration Date | 2010-04-01 |
| Last Update Date | 2010-04-01 |