| NPI | 1447759360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: VA 0813000544) |
| Additional Taxonomies | 103TS0200X Psychologist, School |
| Enumeration Date | 2018-02-06 |
| Last Update Date | 2018-02-06 |