| NPI | 1700851722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: VT 048-0000472) |
| Additional Taxonomies | 103TA0700X Psychologist Adult Development & Aging (Licence: VT 048-0000472) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: VT 048-0000472) | |
| 103TC1900X Psychologist Counseling (Licence: VT 048-0000472) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: VT 048-0000472) | |
| 103T00000X Psychologist (Licence: VT 048-0000472) | |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2013-02-26 |