| NPI | 1780898825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: VA 0810002483) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701001286) |
| 103T00000X Psychologist (Licence: WV 874) | |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2008-09-17 |