| NPI | 1720106743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 4088) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NC 4088) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NC 4088) | |
| 251S00000X (Licence: NC 4088) | |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2016-04-04 |