| NPI | 1437172475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MO 2010036986) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: KS 1918) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: OH 6155) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2011-09-02 |