| NPI | 1326821323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Additional Taxonomies | 103TS0200X Psychologist, School |
| Enumeration Date | 2023-08-15 |
| Last Update Date | 2025-04-27 |