| NPI | 1396783569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NC 6239) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AL 1375) |
| 103TC0700X Psychologist, Clinical (Licence: NC 6239) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: AL 1375) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2023-02-14 |