| NPI | 1124149323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NH 686) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: VT 048-0000565) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2024-08-12 |