| NPI | 1205844883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VT 048-0000860) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VT 000366) |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: VT 860) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: VT 860) | |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2007-07-09 |