| NPI | 1487725834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WV WV936) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WV WV936) |
| 103TF0000X Psychologist, Family (Licence: WV WV936) | |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2016-08-30 |