| NPI | 1538724562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VT 048.0134168) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: VT 048.0134168) |
| Enumeration Date | 2019-05-06 |
| Last Update Date | 2019-12-02 |