| NPI | 1205140746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 8993) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Enumeration Date | 2010-07-26 |
| Last Update Date | 2013-10-30 |