| NPI | 1265009302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MO 2022036658) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: SC 1651) |
| Enumeration Date | 2021-06-08 |
| Last Update Date | 2024-10-29 |