NPI | 1083102628 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
Enumeration Date | 2018-04-30 |
Last Update Date | 2023-01-25 |