| NPI | 1912922501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 8510) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MA 8510) |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: MA 8510) | |
| 103T00000X Psychologist (Licence: MA 8510) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2010-07-28 |