| NPI | 1922095967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VT 042-1117130) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: VT 042-0007130) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2009-03-11 |