| NPI | 1720700404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: VT 047.0133699) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VT 047.0133699) |
| Enumeration Date | 2022-09-19 |
| Last Update Date | 2024-01-29 |