| NPI | 1073757761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MO 2016024854) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: KS 2422) |
| Enumeration Date | 2009-04-24 |
| Last Update Date | 2025-12-23 |