| NPI | 1023326147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NE 901) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 10656) |
| 222Q00000X Developmental Therapist | |
| Enumeration Date | 2010-09-23 |
| Last Update Date | 2016-09-30 |