NPI | 1205988474 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: AZ AZ3877) |
Additional Taxonomies | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: AZ 3877) |
Enumeration Date | 2007-01-17 |
Last Update Date | 2014-08-27 |