| NPI | 1932651247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: VA 0810005476) |
| Additional Taxonomies | 103TP2701X Psychologist Group Psychotherapy (Licence: VA 0810005476) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: VA 0810005476) | |
| 103TF0000X Psychologist Family (Licence: VA 0810005476) | |
| 103TF0200X Psychologist Forensic (Licence: VA 0810005476) | |
| Enumeration Date | 2016-11-03 |
| Last Update Date | 2019-01-17 |