| NPI | 1275689390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TF0200X Psychologist, Forensic (Licence: VA 0810001635) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: DC 1475) |
| 103T00000X Psychologist (Licence: VA 0810001635) | |
| 103TC0700X Psychologist, Clinical (Licence: VA 0810001635) | |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2022-07-21 |