| NPI | 1235302845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KS 4315616699) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: KS 4315616699) |
| 222Q00000X Developmental Therapist (Licence: KS 4315616699) | |
| Enumeration Date | 2008-04-04 |
| Last Update Date | 2008-05-19 |