| NPI | 1508803800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MI 6301016582) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IN 20041809A) |
| 103TC0700X Psychologist, Clinical (Licence: MI 6301016582) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2020-11-11 |