| NPI | 1174734438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CT 001969) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: CT 001969) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2007-07-08 |