| NPI | 1487631347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 1929) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: RI PS00588) |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2007-07-08 |