| NPI | 1538402185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: VA 0810004031) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: VA 0717001058) |
| Enumeration Date | 2013-04-02 |
| Last Update Date | 2013-04-02 |