| NPI | 1477218667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VT 048.0134262) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: VT 048.0134262) |
| Enumeration Date | 2021-11-03 |
| Last Update Date | 2021-12-07 |