| NPI | 1598926644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: LA 951) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: LA 951) |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2010-01-11 |