| NPI | 1780869149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810003165) |
| Additional Taxonomies | 103TH0004X Psychologist, Health (Licence: VA 0810003165) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: VA 0810003165) | |
| Enumeration Date | 2008-01-04 |
| Last Update Date | 2015-01-21 |