| NPI | 1821396755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral |
| 103TC2200X Psychologist Clinical Child & Adolescent | |
| 103TF0000X Psychologist Family | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-03-01 |
| Last Update Date | 2022-08-01 |