| NPI | 1255662730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: CO 2432) |
| Additional Taxonomies | 103TF0000X Psychologist Family (Licence: CO 2432) |
| Enumeration Date | 2010-01-22 |
| Last Update Date | 2018-08-13 |