| NPI | 1972884021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TF0000X Psychologist, Family |
| 103TP2701X Psychologist, Group Psychotherapy | |
| Enumeration Date | 2011-09-02 |
| Last Update Date | 2011-09-02 |