| NPI | 1720405715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CT 003501) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CT 003501) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CT 003501) | |
| Enumeration Date | 2014-03-27 |
| Last Update Date | 2022-09-09 |