| NPI | 1427262138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: VT 048.0134183) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: NY 014595-1) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2019-08-30 |