| NPI | 1063056737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent |
| Additional Taxonomies | 103TH0100X Psychologist Health Service |
| Enumeration Date | 2019-11-05 |
| Last Update Date | 2024-09-25 |