| NPI | 1831346170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: UT 5842642-2501) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2012-12-05 |