| NPI | 1053627968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: LA 735) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: LA 735) |
| 103T00000X Psychologist (Licence: LA 735) | |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| Enumeration Date | 2010-08-30 |
| Last Update Date | 2012-02-29 |