| NPI | 1770099780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: VA 0810005884) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent |
| 103TF0200X Psychologist Forensic (Licence: VA 0810005884) | |
| 103G00000X Clinical Neuropsychologist (Licence: VA 0810005884) | |
| 103TA0700X Psychologist Adult Development & Aging (Licence: VA 0810005884) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: VA 0810005884) | |
| Enumeration Date | 2017-12-28 |
| Last Update Date | 2023-04-30 |