NPI | 1629002951 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: OH 6154) |
Additional Taxonomies | 103T00000X Psychologist (Licence: OH 6154) |
Enumeration Date | 2006-07-11 |
Last Update Date | 2021-11-12 |