| NPI | 1316121320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: RI PS01997) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OK 1156) |
| 103TC0700X Psychologist Clinical (Licence: KS TLMLP1139) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: TX 37162) | |
| Enumeration Date | 2007-12-27 |
| Last Update Date | 2021-09-28 |