| NPI | 1700370574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: VA PPS-0605876) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: VA 0813000941) |
| Enumeration Date | 2018-06-15 |
| Last Update Date | 2024-10-04 |