| NPI | 1225368145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: RI PS00871) |
| Additional Taxonomies | 103TE1100X Psychologist Exercise & Sports (Licence: RI PS00871) |
| Enumeration Date | 2009-12-29 |
| Last Update Date | 2009-12-29 |