| NPI | 1841318433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AK 567) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: AK 567) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2018-07-26 |