| 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 |