| NPI | 1578727517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 8977) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: RI PS01066) |
| 103TC0700X Psychologist, Clinical (Licence: MD 04030) | |
| 103TC0700X Psychologist, Clinical (Licence: NY 016314) | |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2015-01-06 |