| NPI | 1932148541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TP2701X Psychologist, Group Psychotherapy |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 2714) |
| 103TF0000X Psychologist, Family | |
| 103TF0200X Psychologist, Forensic | |
| 103TP0814X Psychologist, Psychoanalysis | |
| 103T00000X Psychologist (Licence: MA 2714) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2025-09-11 |