| NPI | 1871580779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VT 042-0005715) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: VT 042-0005715) |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2009-03-17 |