| NPI | 1053827451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: VA 0810005840) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: VA 0810005840) |
| Enumeration Date | 2017-12-20 |
| Last Update Date | 2017-12-20 |