| NPI | 1477577922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: LA 457) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: LA SP301) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2007-07-08 |