| NPI | 1639339476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810004800) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: SC 1153) |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2013-09-11 |