| NPI | 1659601961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: OR 1239) |
| Additional Taxonomies | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: OR 1239) |
| 103TS0200X Psychologist, School (Licence: OR 1239) | |
| Enumeration Date | 2010-01-08 |
| Last Update Date | 2010-01-08 |