| NPI | 1689687709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VT 0470000715) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VT 047000715) |
| 103TH0100X Psychologist, Health Service (Licence: VT 0470000715) | |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2023-04-19 |