| NPI | 1770706053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TX 3-0929) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 3-0929) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2025-04-24 |