| NPI | 1043479686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CO PSY-3496) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TN 3204) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TN 3204) | |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2024-08-19 |