| NPI | 1306989686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: VA 0810007967) |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2023-09-25 |