| NPI | 1386014488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: TN 3756) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: TN 3756) |
| Enumeration Date | 2015-10-01 |
| Last Update Date | 2020-10-29 |