| NPI | 1912031584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NV PY0258) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: NV PY0258) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2014-09-18 |