| NPI | 1043508054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: VA 0810004435) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: VA 0810004435) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: VA 0810004435) | |
| 103TC0700X Psychologist, Clinical (Licence: VA 0810004435) | |
| 103TF0000X Psychologist, Family (Licence: VA 0810004435) | |
| 103TS0200X Psychologist, School (Licence: VA 0810004435) | |
| Enumeration Date | 2011-07-12 |
| Last Update Date | 2011-07-12 |