| NPI | 1609426618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
| 103TF0000X Psychologist, Family | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| Enumeration Date | 2019-09-12 |
| Last Update Date | 2019-12-02 |