| NPI | 1932306834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CO 1141) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CT 1141) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CO 1141) | |
| 103TF0000X Psychologist, Family (Licence: CO 1141) | |
| 103TH0004X Psychologist, Health (Licence: CO 1141) | |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2007-07-08 |