| NPI | 1902199151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: PR 1686) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PR 1686) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: PR 1686) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: PR 1686) | |
| Enumeration Date | 2011-05-20 |
| Last Update Date | 2019-01-07 |