| NPI | 1770811721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810002691) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: VA 0810002691) |
| 103TF0000X Psychologist, Family (Licence: VA 0810002691) | |
| 103TH0004X Psychologist, Health (Licence: VA 0810002691) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: VA 0810002691) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: VA 0810002691) | |
| Enumeration Date | 2009-12-03 |
| Last Update Date | 2015-02-12 |