| NPI | 1568918035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PR 1154) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities | |
| Enumeration Date | 2016-08-25 |
| Last Update Date | 2016-08-25 |