| NPI | 1104986637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: VT 695) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: VT 695) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: VT 695) | |
| 103TC0700X Psychologist, Clinical (Licence: VT 695) | |
| 103TC1900X Psychologist, Counseling (Licence: VT 695) | |
| 103TF0000X Psychologist, Family (Licence: VT 695) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2025-09-11 |