| NPI | 1477645224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0107001351) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: LA 1426) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2018-03-09 |