| NPI | 1124146105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VT 48-618) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NH 421) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2008-10-29 |