| NPI | 1952395170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TP0814X Psychologist, Psychoanalysis (Licence: NC 1556) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NC 1556) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NC 1556) | |
| 103T00000X Psychologist (Licence: NC 1556) | |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2015-09-19 |