| NPI | 1841309549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 3123) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MD 3123) |
| 103TF0000X Psychologist, Family (Licence: MD 3123) | |
| 103TP0814X Psychologist, Psychoanalysis (Licence: MD 3123) | |
| 103T00000X Psychologist (Licence: MD 3123) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2014-05-23 |