| NPI | 1184758823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: RI PS00683) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA 6386) |
| 103T00000X Psychologist (Licence: NH 844) | |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2007-07-08 |