| NPI | 1225480171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: RI PS00774) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA 4207) |
| Enumeration Date | 2016-07-04 |
| Last Update Date | 2016-07-04 |