| NPI | 1326715889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TM1800X Psychologist, Intellectual & Developmental Disabilities |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Enumeration Date | 2021-08-24 |
| Last Update Date | 2021-08-24 |