| NPI | 1437220365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: IA 00622) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IA 622) |
| 103TH0004X Psychologist, Health (Licence: IA 00210) | |
| 103TS0200X Psychologist, School (Licence: IA 00622) | |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2010-04-29 |