| NPI | 1811056468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: MA 3458) |
| Additional Taxonomies | 103TA0700X Psychologist Adult Development & Aging (Licence: MA 3458) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: MA 3458) | |
| 103TC0700X Psychologist Clinical (Licence: MA 3458) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MA 3458) | |
| 103TE1100X Psychologist Exercise & Sports (Licence: MA 3458) | |
| 103TF0000X Psychologist Family (Licence: MA 3458) | |
| 103TH0100X Psychologist Health Service (Licence: MA 3458) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: MA 3458) | |
| 103TP0814X Psychologist Psychoanalysis (Licence: MA 3458) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: MA 3458) | |
| 103TR0400X Psychologist Rehabilitation (Licence: MA 3458) | |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2021-08-01 |