| NPI | 1417904954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: RI PS00557) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 6994) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2007-12-26 |