| NPI | 1376650374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WV 212) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: WV 212) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2022-07-21 |