| NPI | 1316276595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: PA PS017500) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: DC PSY10000589) |
| Enumeration Date | 2009-12-16 |
| Last Update Date | 2016-07-29 |