| NPI | 1619918737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: SC 1020) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC 1020) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2018-02-28 |