| NPI | 1215010665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: GA PSY002840) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: GA PSY002840) |
| Enumeration Date | 2006-10-21 |
| Last Update Date | 2007-07-08 |