| NPI | 1427238708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TA0700X Psychologist Adult Development & Aging |
| 103TB0200X Psychologist Cognitive & Behavioral | |
| 103TC0700X Psychologist Clinical (Licence: RI PS00793) | |
| 103TC1900X Psychologist Counseling | |
| 103TP2701X Psychologist Group Psychotherapy | |
| 103TS0200X Psychologist School | |
| Enumeration Date | 2007-11-05 |
| Last Update Date | 2007-11-05 |