| NPI | 1992063184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: KS T-LP1978) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KS T-LP1978) |
| Enumeration Date | 2012-04-25 |
| Last Update Date | 2013-12-06 |