| NPI | 1174688899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: RI PS01560) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY 4308) |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2016-06-23 |