| NPI | 1437335734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: VA 0810003784) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: VA 0810003784) |
| 103TF0200X Psychologist Forensic (Licence: VA 0810003784) | |
| 103TP0814X Psychologist Psychoanalysis (Licence: VA 0810003784) | |
| 103TS0200X Psychologist School (Licence: VA 0810003784) | |
| Enumeration Date | 2008-01-16 |
| Last Update Date | 2019-02-06 |