| NPI | 1831158476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: VA 0810001993) |
| Additional Taxonomies | 103TF0200X Psychologist Forensic (Licence: VA 0810001993) |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2007-07-08 |