| NPI | 1265524029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: DE B10000121) |
| Additional Taxonomies | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: DE B10000121) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2011-09-10 |