| NPI | 1639473986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 04203) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MD 04203) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MD 04203) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: VA 0810004674) | |
| 103TC0700X Psychologist, Clinical (Licence: VA 0810004674) | |
| 103T00000X Psychologist (Licence: VA 0810004674) | |
| Enumeration Date | 2010-12-30 |
| Last Update Date | 2016-08-09 |