| NPI | 1063699668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IA 01022) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: IA 000494) |
| Enumeration Date | 2008-01-25 |
| Last Update Date | 2008-03-04 |