NPI | 1972654978 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: VT 634) |
Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: VT 634) |
103TC2200X Psychologist, Clinical Child & Adolescent (Licence: VT 634) | |
103T00000X Psychologist (Licence: VT 634) | |
103TP2701X Psychologist, Group Psychotherapy (Licence: VT 634) | |
Enumeration Date | 2007-01-16 |
Last Update Date | 2007-07-08 |