| NPI | 1376034843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA PSY11851) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: RI PS01981) |
| 103TC0700X Psychologist, Clinical (Licence: NY 026019) | |
| Enumeration Date | 2018-05-21 |
| Last Update Date | 2024-07-17 |