| NPI | 1215298336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NH #823) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NH 823) |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2012-06-05 |