| NPI | 1477621605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: RI 383) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA 2093) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2007-07-08 |