| NPI | 1558551937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: AZ 3106) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: AZ 3106) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: AZ 3106) | |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2007-07-31 |