| NPI | 1043561202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent |
| 103TS0200X Psychologist, School | |
| Enumeration Date | 2012-09-27 |
| Last Update Date | 2012-09-27 |