| NPI | 1811135668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810002005) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: VA 0810002005) |
| 103TH0004X Psychologist, Health | |
| Enumeration Date | 2009-02-02 |
| Last Update Date | 2009-02-02 |