| NPI | 1376682377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WI 63462-020) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NM MD2010-0691) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: NM MD2010-0691) | |
| 103T00000X Psychologist (Licence: WI 63462-020) | |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2026-03-02 |