| NPI | 1508060872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TN 00683) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TN P000683) |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2025-12-12 |