| NPI | 1750311304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810005145) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA ps005784L) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2022-02-17 |