| NPI | 1417304239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MO 2019028609) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: KS 2712) |
| 103TC0700X Psychologist, Clinical (Licence: IN 20043261A) | |
| Enumeration Date | 2016-05-22 |
| Last Update Date | 2025-12-05 |