| NPI | 1912376419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NH 1541) |
| Additional Taxonomies | 103TS0200X Psychologist, School |
| Enumeration Date | 2015-09-15 |
| Last Update Date | 2022-04-20 |