| NPI | 1821396755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 07627) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103TF0000X Psychologist, Family | |
| Enumeration Date | 2011-03-01 |
| Last Update Date | 2026-09-21 |