| NPI | 1215963624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: RI PS00686) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 4203) |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2012-10-08 |