| NPI | 1104981364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VT 048-0000896) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: VT 048-0000896) |
| 103T00000X Psychologist (Licence: VT 048-0000896) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: VT 048-0000896) | |
| 103TC1900X Psychologist, Counseling (Licence: VT 048-0000896) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2024-05-31 |