| NPI | 1386191328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: AZ 4875) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA 2012719) |
| Enumeration Date | 2016-09-07 |
| Last Update Date | 2018-04-04 |