| NPI | 1710017686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC 27024) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MO 2018032451) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: OK 34192) | |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2023-02-22 |