| NPI | 1972081990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 10872) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MA 10872) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MA 10872) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: MA 10872) | |
| Enumeration Date | 2018-08-01 |
| Last Update Date | 2018-08-01 |