| NPI | 1952323529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: ND 385) |
| Additional Taxonomies | 103TP0814X Psychologist, Psychoanalysis (Licence: ND 385) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MN LP6544) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2025-11-25 |