| NPI | 1942471263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 8817) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MA 8817) |
| 103TS0200X Psychologist, School (Licence: MA 417919) | |
| Enumeration Date | 2008-03-13 |
| Last Update Date | 2008-03-13 |