| NPI | 1497821672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MT 328) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: MT 328) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2012-10-31 |