| NPI | 1558327932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WI 1312-57) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WI 1312-057) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2010-08-04 |