| NPI | 1396894655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810001910) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: VA 0810001910) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2007-07-08 |