| NPI | 1508298423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 05557) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MD 05557) |
| Enumeration Date | 2013-08-01 |
| Last Update Date | 2016-10-04 |