| NPI | 1356426001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MD 06930) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CO 2911) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2022-11-30 |