| NPI | 1134601826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: CA 32003) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IA 090186) |
| 103T00000X Psychologist (Licence: CA 32003) | |
| 103TC0700X Psychologist Clinical (Licence: IA 090186) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: IA 090186) | |
| Enumeration Date | 2018-08-30 |
| Last Update Date | 2023-07-27 |