| NPI | 1366414781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: VA 0701001684) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: VA 0717000403) |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2007-07-08 |