| NPI | 1578577508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VT 048-0000475) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: VT 048-0000475) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: VT 048-0000475) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2012-06-14 |