| NPI | 1699394890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist School |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral |
| 103TC2200X Psychologist Clinical Child & Adolescent | |
| Enumeration Date | 2020-04-09 |
| Last Update Date | 2020-04-09 |