| NPI | 1437568144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 10329) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TC0700X Psychologist, Clinical (Licence: RI PS01503) | |
| Enumeration Date | 2014-08-06 |
| Last Update Date | 2017-04-11 |