| NPI | 1821585100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: VA PPS-0603682) |
| Additional Taxonomies | 103TS0200X Psychologist, School |
| Enumeration Date | 2018-04-22 |
| Last Update Date | 2024-09-03 |