| NPI | 1073908224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY9302) |
| Enumeration Date | 2015-04-04 |
| Last Update Date | 2019-04-15 |