| NPI | 1699493783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: VT 048-0134862) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CT 004231) |
| 103T00000X Psychologist (Licence: CT 004231) | |
| Enumeration Date | 2022-08-16 |
| Last Update Date | 2024-01-23 |