| NPI | 1699899674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA 34415) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA 34415) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NY 018596) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 018596) | |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2023-11-02 |