| NPI | 1407840648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: VT 042-0000722) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA 4767) |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2009-03-27 |