| NPI | 1326199480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: VA 0810003294) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NY 0149931) |
| 103TS0200X Psychologist School (Licence: VA PPS0600035) | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2007-07-08 |