| NPI | 1831133305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: PR 1984) |
| Additional Taxonomies | 103TF0000X Psychologist Family (Licence: PR 1984) |
| 103TF0200X Psychologist Forensic (Licence: PR 1984) | |
| 103T00000X Psychologist (Licence: PR 1984) | |
| 103TA0700X Psychologist Adult Development & Aging (Licence: PR 1984) | |
| 103TC0700X Psychologist Clinical (Licence: PR 1984) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: PR 1984) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2021-09-20 |