| NPI | 1851900716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MD 026424) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MD 026424) |
| 103T00000X Psychologist (Licence: MD 026424) | |
| Enumeration Date | 2020-07-27 |
| Last Update Date | 2023-09-16 |