| NPI | 1447404918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TX 2-3732) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: TX 2-3732) |
| Enumeration Date | 2008-11-11 |
| Last Update Date | 2014-12-02 |