| NPI | 1780957837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103TP0814X Psychologist, Psychoanalysis | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2012-02-21 |
| Last Update Date | 2012-02-21 |