| NPI | 1861461907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MA 2540) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MA 2540) |
| 103TA0700X Psychologist Adult Development & Aging (Licence: MA 2540) | |
| 103TC1900X Psychologist Counseling (Licence: MA 2540) | |
| 103TF0200X Psychologist Forensic (Licence: MA 2540) | |
| 103TH0100X Psychologist Health Service (Licence: MA 2540) | |
| 103T00000X Psychologist (Licence: MA 2540) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2007-07-08 |