| NPI | 1326320920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: HI PSY-1841) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: HI PSY-1841) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: HI PSY-1841) | |
| Enumeration Date | 2011-09-09 |
| Last Update Date | 2023-08-03 |