| NPI | 1134138662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: DE B1-0001104) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OH 5676) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2018-02-13 |