| NPI | 1730102245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: GA GA002374) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: GA 002374) |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2009-03-04 |