| NPI | 1972579027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: VT 048-0000757) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: VT 100-0000030) |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2007-07-08 |