| NPI | 1760535793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WV 823) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MD 03802) |
| 103TC0700X Psychologist, Clinical (Licence: VA 810003124) | |
| 103TF0200X Psychologist, Forensic (Licence: WV 823) | |
| 103TF0200X Psychologist, Forensic (Licence: MD 03802) | |
| 103TF0200X Psychologist, Forensic (Licence: VA 810003124) | |
| Enumeration Date | 2007-01-21 |
| Last Update Date | 2007-07-09 |