| NPI | 1871636217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: VA 0810003315) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: VA 0810003315) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: VA 0810003315) | |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2007-07-08 |