| NPI | 1144485673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: RI PS01079) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: FL PY8047) |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2019-08-02 |