| NPI | 1174666937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2012-01-23 |