| NPI | 1629350194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VT 048.009946) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: SC 1265) |
| Enumeration Date | 2011-09-12 |
| Last Update Date | 2017-02-28 |