| NPI | 1043248313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CO 2843) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CO 2843) |
| 103TC0700X Psychologist, Clinical (Licence: CO 2843) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: CO 2843) | |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2010-02-23 |