| NPI | 1801558192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VT 048.0134278) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO PSY.0005607) |
| Enumeration Date | 2021-10-13 |
| Last Update Date | 2021-12-29 |