| NPI | 1952348542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6351000181) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
| 103TC0700X Psychologist, Clinical (Licence: MI 006920) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2023-03-14 |