| NPI | 1588090823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 9809) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: RI PS01401) |
| 103TC0700X Psychologist, Clinical (Licence: NH 1651) | |
| Enumeration Date | 2013-09-18 |
| Last Update Date | 2025-12-22 |