NPI | 1285633040 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810002364) |
Additional Taxonomies | 103TS0200X Psychologist, School (Licence: VA 0803000051) |
Enumeration Date | 2005-07-14 |
Last Update Date | 2014-08-01 |