| NPI | 1265900922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: WI 3611-57) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: WI 3611-57) |
| Enumeration Date | 2018-11-10 |
| Last Update Date | 2018-11-10 |