| NPI | 1669026431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS019976) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: DE B1-0001191) |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| Enumeration Date | 2019-07-30 |
| Last Update Date | 2023-10-05 |