| NPI | 1376764670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: LA 1189) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VT 048.0135333) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2026-01-28 |