| NPI | 1891907135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: VA 0904000271) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: VA 0904000271) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2007-07-08 |