| NPI | 1053557249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: AL 1630) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: UT 293257-2501) |
| Enumeration Date | 2008-12-18 |
| Last Update Date | 2014-03-13 |