| NPI | 1396856803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: VA 0810008509) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2024-05-13 |