| NPI | 1023460128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TN 3373) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: AL 1989) |
| Enumeration Date | 2016-07-13 |
| Last Update Date | 2016-10-28 |