| NPI | 1073694790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: RI PS00256) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA 3588) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2007-07-09 |