| NPI | 1780671719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: VT 042-0010667) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: VT 042-0010667) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2009-03-12 |