| NPI | 1669900320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MT PSY-PSY-LIC-2208) |
| Additional Taxonomies | 103TS0200X Psychologist School (Licence: MT 137291) |
| Enumeration Date | 2017-05-25 |
| Last Update Date | 2017-05-25 |