| NPI | 1972639904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 6234) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: MA 6234) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MA 6234) | |
| 103T00000X Psychologist (Licence: MA 6234) | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: MA 6234) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: MA 6234) | |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2024-09-19 |