| NPI | 1053429894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: FL 1958) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NH 503) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NH 503) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2007-10-30 |