| NPI | 1851887251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TF0200X Psychologist, Forensic (Licence: AZ PSY-004980) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: AZ PSY-004980) |
| 103TC1900X Psychologist, Counseling (Licence: AZ PSY-004980) | |
| 103TF0000X Psychologist, Family (Licence: AZ PSY-004980) | |
| Enumeration Date | 2018-07-09 |
| Last Update Date | 2018-07-09 |