| NPI | 1528160108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: VA 0810000947) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: WV 454) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2008-05-29 |