| NPI | 1811122260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| Enumeration Date | 2009-05-28 |
| Last Update Date | 2012-11-05 |