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 |