| NPI | 1205972528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: RI PS02315) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CT 002738) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2025-09-11 |