| NPI | 1821241365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810004622) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810006622) |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2022-05-16 |