| NPI | 1780636209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: SC 876) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC 000876) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2018-03-22 |