NPI | 1669564407 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: DE B10000589) |
Additional Taxonomies | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: DE B10000589) |
Enumeration Date | 2006-09-29 |
Last Update Date | 2012-09-13 |