| NPI | 1225253321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: LA 924) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: LA 924) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2010-11-16 |