Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 0810002082 | VA |
NPI | 1114122983 |
---|---|
Provider Name | Moshe Shtuhl |
First Address | Reston, VA 20190-5325 |
Second Address | Reston, VA 20190-5325 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2007 |
Last Update Date | 08/07/2007 |