| NPI | 1093904260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: GA PSY002983) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: GA PSY002983) |
| 103TF0000X Psychologist, Family (Licence: GA PSY002983) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: GA PSY002983) | |
| Enumeration Date | 2007-10-23 |
| Last Update Date | 2007-10-23 |