| NPI | 1801096334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: OR OR1120) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: OR 1120) |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2012-04-17 |