| NPI | 1629426770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AR 18-22P) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: AR 18-22P) |
| 103TC1900X Psychologist, Counseling (Licence: AR 18-22P) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: AR 18-22P) | |
| Enumeration Date | 2016-05-31 |
| Last Update Date | 2019-07-24 |