| NPI | 1831558238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 10216) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: VT 048.0117056) |
| Enumeration Date | 2016-02-15 |
| Last Update Date | 2019-04-21 |