| NPI | 1912063447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TF0200X Psychologist, Forensic (Licence: VT 47-0000310) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: VT 47-0000310) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2007-07-08 |