| NPI | 1336451681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TB0200X Psychologist Cognitive & Behavioral | |
| 103TF0000X Psychologist Family | |
| Enumeration Date | 2010-07-01 |
| Last Update Date | 2010-07-01 |