| NPI | 1982891347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: VA 0810002093) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: VA 0810002093) |
| 103TE1100X Psychologist Exercise & Sports (Licence: VA 0810002093) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: VA 0810002093) | |
| Enumeration Date | 2007-10-01 |
| Last Update Date | 2007-10-01 |