| 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 |