| NPI | 1194975433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) |
| 103TC0700X Psychologist Clinical (Licence: GA PSY0003175) | |
| 103TF0000X Psychologist Family | |
| 103TS0200X Psychologist School | |
| Enumeration Date | 2008-09-23 |
| Last Update Date | 2023-08-07 |