| NPI | 1972624179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MD 04422) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MD 04422) |
| 103TF0000X Psychologist Family (Licence: MD 04422) | |
| 103TF0200X Psychologist Forensic (Licence: MD 04422) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: MD 04422) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: MD 04422) | |
| 1041C0700X Social Worker Clinical (Licence: MD 11809) | |
| 1041C0700X Social Worker Clinical (Licence: DC LC3000754) | |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2012-02-03 |