| NPI | 1710657069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: PA PS019029) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: VA 0810008966) |
| Enumeration Date | 2021-09-17 |
| Last Update Date | 2026-01-07 |