| 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 |