| NPI | 1881278521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810008680) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: VA PPS-0607703) |
| Enumeration Date | 2021-05-10 |
| Last Update Date | 2024-10-03 |