| NPI | 1316150683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NH 887) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VT 831) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2013-07-05 |