| NPI | 1801767009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
| 103TH0004X Psychologist, Health | |
| Enumeration Date | 2025-09-12 |
| Last Update Date | 2025-09-12 |