| NPI | 1801983820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: CO PSY.0005721) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: TN P1703) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2022-02-08 |