| NPI | 1689669038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: TN 2386) |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2025-04-29 |