| NPI | 1811202443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CO PSY.0003944) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO PSY.0003944) |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| Enumeration Date | 2010-08-06 |
| Last Update Date | 2021-07-07 |