| NPI | 1356428049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VT 042-0007661) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: VT 042-0007661) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2009-05-13 |