| NPI | 1740379577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: VA 0810002136) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MD 02371) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2007-07-08 |