| NPI | 1790092724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 4297) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: MD 4297) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MD 4297) | |
| 103TC0700X Psychologist, Clinical (Licence: MD 4297) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MD 4297) | |
| 103TF0000X Psychologist, Family (Licence: MD 4297) | |
| Enumeration Date | 2010-09-13 |
| Last Update Date | 2017-02-07 |