| NPI | 1275551673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810002716) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: VA 0810002716) |
| 103TH0100X Psychologist, Health Service (Licence: VA 0810002716) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2007-07-08 |