| NPI | 1710490768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS019606) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: DE B1-0001097) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: DE B1-0001097) | |
| Enumeration Date | 2017-11-13 |
| Last Update Date | 2022-07-20 |