| NPI | 1306887575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: PA PS02499-L) |
| Additional Taxonomies | 103TS0200X Psychologist School |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2007-07-26 |