| NPI | 1831109594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MA 4516) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 4516) |
| 103T00000X Psychologist (Licence: MA 4516) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: MA 4516) | |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2007-07-08 |