| NPI | 1063950715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 3804) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent |
| 103TF0200X Psychologist, Forensic | |
| Enumeration Date | 2017-02-02 |
| Last Update Date | 2024-12-11 |