| NPI | 1801041082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 1926) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: OR 1926) |
| 103TF0200X Psychologist, Forensic (Licence: OR 1926) | |
| Enumeration Date | 2008-12-01 |
| Last Update Date | 2008-12-01 |