| NPI | 1669792180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CT 002995) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 36401) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TX 33851) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA 21731) | |
| Enumeration Date | 2010-06-07 |
| Last Update Date | 2023-11-16 |