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 |