| NPI | 1982826947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 4066) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: MA 4066) |
| 103TC0700X Psychologist, Clinical (Licence: MA 4066) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MA 4066) | |
| 103TF0000X Psychologist, Family (Licence: MA 4066) | |
| 103TF0200X Psychologist, Forensic (Licence: MA 4066) | |
| 103TH0004X Psychologist, Health (Licence: MA 4066) | |
| 103TH0100X Psychologist, Health Service (Licence: MA 4066) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: MA 4066) | |
| 103TS0200X Psychologist, School (Licence: MA 4066) | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2007-07-08 |