| NPI | 1134765159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810008529) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: GA PS-P00257) |
| Enumeration Date | 2019-11-25 |
| Last Update Date | 2024-07-11 |