| NPI | 1821014556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: AL 1202) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: AL 1202) |
| 103TC0700X Psychologist Clinical (Licence: AL 1202) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: AL 1202) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2007-07-12 |