| NPI | 1538996830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810008519) |
| Enumeration Date | 2024-09-19 |
| Last Update Date | 2024-09-19 |