| NPI | 1497722789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: VA 0810-002607) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NC 3198) |
| Enumeration Date | 2006-03-05 |
| Last Update Date | 2012-11-28 |