| NPI | 1114165792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 103TF0000X Psychologist, Family | |
| 103TS0200X Psychologist, School | |
| Enumeration Date | 2009-02-04 |
| Last Update Date | 2009-02-04 |