| NPI | 1578597662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: VA 810001442) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810001442) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2014-03-12 |