| NPI | 1295771038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 11453) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VT 048.0134153) |
| 103TC0700X Psychologist, Clinical (Licence: FL PY7006) | |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2026-06-19 |