| NPI | 1851388805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NH 261) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NH 261) |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: NH 261) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NH 261) | |
| 103TH0100X Psychologist, Health Service (Licence: NH 261) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: NH 261) | |
| 103TS0200X Psychologist, School (Licence: NH 26231) | |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2007-07-09 |