| 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 |