| NPI | 1144232885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NE 334) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NE 334) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2026-04-21 |