| NPI | 1871007849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 06384) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: HI PSY-1693) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MD 06384) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: HI psy-1693) | |
| Enumeration Date | 2017-11-28 |
| Last Update Date | 2021-07-20 |