| NPI | 1659467967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VT 48.0061308) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 8987) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2022-10-13 |