| NPI | 1114349867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: VA 0810002117) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: VA 0810002117) |
| Enumeration Date | 2014-01-15 |
| Last Update Date | 2015-11-03 |