| NPI | 1235216854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: RI PS01544) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301013090) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2023-07-10 |